1
|
Saxena AR, Lyle SA, Khavandi K, Qiu R, Whitlock M, Esler WP, Kim AM. A phase 2a, randomized, double-blind, placebo-controlled, three-arm, parallel-group study to assess the efficacy, safety, tolerability and pharmacodynamics of PF-06835919 in patients with non-alcoholic fatty liver disease and type 2 diabetes. Diabetes Obes Metab 2023; 25:992-1001. [PMID: 36515213 DOI: 10.1111/dom.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
AIM To assess the safety, tolerability and pharmacodynamics (PD) of the ketohexokinase inhibitor PF-06835919 in participants with non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D). MATERIALS AND METHODS This double-blind, placebo-controlled, parallel-group study enrolled adults with NAFLD (≥ 8% whole liver fat [WLF] using MRI proton density fat fraction [MRI-PDFF]) and T2D on stable doses of metformin (≥ 500 mg/day). Participants received once-daily placebo, PF-06835919 150 or 300 mg for 16 weeks. Randomization (1:1:1) was via an interactive response technology system. Endpoints included percentage change from baseline (CFB) in WLF using MRI-PDFF (primary endpoint) and CFB in HbA1c (co-primary endpoint) at 16 weeks, PD, safety and tolerability. RESULTS Among 164 participants randomized and treated, 145 completed the treatment (placebo, n = 50; PF-06835919 150 mg, n = 46; PF-06835919 300 mg, n = 49). At week 16, least squares mean (90% confidence interval) percentage CFB in WLF was -5.26% (-12.86%, 2.99%), -17.05% (-24.01%, -9.46%) and -19.13% (-25.51%, -12.20%) in the placebo, PF-06835919 150-mg and 300-mg groups, respectively (PF-06835919 300-mg group vs. placebo, P = .0288). Modest numerical reductions in HbA1c were observed in all groups that did not reach statistical significance. Treatment-emergent adverse event incidence was similar across groups (40.7%, 45.5% and 32.7% in the placebo, PF-06835919 150-mg and 300-mg groups, respectively), with no apparent dose-related trend. CONCLUSIONS PF-06835919 administration over 16 weeks was generally safe and well tolerated and resulted in reductions in WLF in participants with NAFLD and T2D.
Collapse
Affiliation(s)
- Aditi R Saxena
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
| | - Stephanie-An Lyle
- Early Clinical Development, Pfizer Inc, Cambridge, Massachusetts, USA
| | - Kaivan Khavandi
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
| | - Ruolun Qiu
- Early Clinical Development, Pfizer Inc, Cambridge, Massachusetts, USA
| | - Mark Whitlock
- Early Clinical Development, Pfizer Inc, Cambridge, UK
| | - William P Esler
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
| | - Albert M Kim
- Pfizer Worldwide Research and Development, Cambridge, Massachusetts, USA
| |
Collapse
|
2
|
Saxena AR, Gorman DN, Esquejo RM, Bergman A, Chidsey K, Buckeridge C, Griffith DA, Kim AM. Danuglipron (PF-06882961) in type 2 diabetes: a randomized, placebo-controlled, multiple ascending-dose phase 1 trial. Nat Med 2021; 27:1079-1087. [PMID: 34127852 DOI: 10.1038/s41591-021-01391-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/10/2021] [Indexed: 02/07/2023]
Abstract
Agonism of the glucagon-like peptide-1 receptor (GLP-1R) results in glycemic lowering and body weight loss and is a therapeutic strategy to treat type 2 diabetes (T2D) and obesity. We developed danuglipron (PF-06882961), an oral small-molecule GLP-1R agonist and found it had comparable efficacy to injectable peptidic GLP-1R agonists in a humanized mouse model. We then completed a placebo-controlled, randomized, double-blind, multiple ascending-dose phase 1 study ( NCT03538743 ), in which we enrolled 98 patients with T2D on background metformin and randomized them to receive multiple ascending doses of danuglipron or placebo for 28 d, across eight cohorts. The primary outcomes were assessment of adverse events (AEs), safety laboratory tests, vital signs and 12-lead electrocardiograms. Most AEs were mild, with nausea, dyspepsia and vomiting most commonly reported. There were no clinically meaningful AEs in laboratory values across groups. Heart rate generally increased with danuglipron treatment at day 28, but no heart-rate AEs were reported. Systolic blood pressure was slightly decreased and changes in diastolic blood pressure were similar with danuglipron treatment at day 28, compared with placebo. There were no clinically meaningful electrocardiogram findings. In this study in T2D, danuglipron was generally well tolerated, with a safety profile consistent with the mechanism of action of GLP-1R agonism.
Collapse
Affiliation(s)
- Aditi R Saxena
- Pfizer Worldwide Research and Development, Cambridge, MA, USA.
| | - Donal N Gorman
- Pfizer Worldwide Research and Development, Cambridge, UK
| | - Ryan M Esquejo
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Arthur Bergman
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Kristin Chidsey
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | | | | | - Albert M Kim
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| |
Collapse
|
3
|
Amin NB, Carvajal-Gonzalez S, Purkal J, Zhu T, Crowley C, Perez S, Chidsey K, Kim AM, Goodwin B. Targeting diacylglycerol acyltransferase 2 for the treatment of nonalcoholic steatohepatitis. Sci Transl Med 2020; 11:11/520/eaav9701. [PMID: 31776293 DOI: 10.1126/scitranslmed.aav9701] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/25/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) is characterized by the accumulation of hepatocyte triglycerides, the synthesis of which is catalyzed by diacylglycerol acyltransferases (DGATs). Here, we investigate DGAT2 as a potential therapeutic target using an orally administered, selective DGAT2 inhibitor, PF-06427878. Treatment with PF-06427878 resulted in the reduction of hepatic and circulating plasma triglyceride concentrations and decreased lipogenic gene expression in rats maintained on a Western-type diet. In a mouse model of NASH, histological improvements in steatosis, ballooning, and fibrosis were evident in the livers of animals receiving PF-06427878 compared with mice treated with vehicle alone. We extended these nonclinical studies to two phase 1 studies in humans [NCT02855177 (n = 24) and NCT02391623 (n = 39; n = 38 completed)] and observed that PF-06427878 was well tolerated and influenced markers of liver function (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin) in healthy adults, with statistically significant reductions from baseline at day 14 in participants treated with PF-06427878 1500 milligrams per day (P < 0.05). Moreover, magnetic resonance imaging using proton density fat fraction showed that PF-06427878 1500 milligrams per day reduced hepatic steatosis in healthy adult participants. Our findings highlight DGAT2 inhibition by a small, potent, selective compound as a potential therapeutic approach for the treatment of NASH.
Collapse
Affiliation(s)
- Neeta B Amin
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA.
| | | | - Julie Purkal
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| | - Tong Zhu
- Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| | - Collin Crowley
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| | - Sylvie Perez
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| | - Kristin Chidsey
- Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| | - Albert M Kim
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| | - Bryan Goodwin
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA 02139, USA
| |
Collapse
|
4
|
Roth Flach RJ, Su C, Bollinger E, Cortes C, Robertson AW, Opsahl AC, Coskran TM, Maresca KP, Keliher EJ, Yates PD, Kim AM, Kalgutkar AS, Buckbinder L. Myeloperoxidase inhibition in mice alters atherosclerotic lesion composition. PLoS One 2019; 14:e0214150. [PMID: 30889221 PMCID: PMC6424399 DOI: 10.1371/journal.pone.0214150] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/07/2019] [Indexed: 01/09/2023] Open
Abstract
Myeloperoxidase (MPO) is a highly abundant protein within the neutrophil that is associated with lipoprotein oxidation, and increased plasma MPO levels are correlated with poor prognosis after myocardial infarct. Thus, MPO inhibitors have been developed for the treatment of heart failure and acute coronary syndrome in humans. 2-(6-(5-Chloro-2-methoxyphenyl)-4-oxo-2-thioxo-3,4-dihydropyrimidin-1(2H)-yl)acetamide PF-06282999 is a recently described selective small molecule mechanism-based inactivator of MPO. Here, utilizing PF-06282999, we investigated the role of MPO to regulate atherosclerotic lesion formation and composition in the Ldlr-/- mouse model of atherosclerosis. Though MPO inhibition did not affect lesion area in Ldlr-/- mice fed a Western diet, reduced necrotic core area was observed in aortic root sections after MPO inhibitor treatment. MPO inhibition did not alter macrophage content in and leukocyte homing to atherosclerotic plaques. To assess non-invasive monitoring of plaque inflammation, [18F]-Fluoro-deoxy-glucose (FDG) was administered to Ldlr-/- mice with established atherosclerosis that had been treated with clinically relevant doses of PF-06282999, and reduced FDG signal was observed in animals treated with a dose of PF-06282999 that corresponded with reduced necrotic core area. These data suggest that MPO inhibition does not alter atherosclerotic plaque area or leukocyte homing, but rather alters the inflammatory tone of atherosclerotic lesions; thus, MPO inhibition could have utility to promote atherosclerotic lesion stabilization and prevent atherosclerotic plaque rupture.
Collapse
Affiliation(s)
- Rachel J. Roth Flach
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Chunyan Su
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Eliza Bollinger
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Christian Cortes
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Andrew W. Robertson
- Drug Safety Research and Development Global Pathology, Pfizer Inc., Groton, Connecticut, United States of America
| | - Alan C. Opsahl
- Drug Safety Research and Development Global Pathology, Pfizer Inc., Groton, Connecticut, United States of America
| | - Timothy M. Coskran
- Drug Safety Research and Development Global Pathology, Pfizer Inc., Groton, Connecticut, United States of America
| | - Kevin P. Maresca
- Early Clinical Development, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Edmund J. Keliher
- Early Clinical Development, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Phillip D. Yates
- Early Clinical Development, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Albert M. Kim
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Amit S. Kalgutkar
- Medicine Design, Pfizer Inc., Cambridge, Massachusetts, United States of America
| | - Leonard Buckbinder
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, Massachusetts, United States of America
| |
Collapse
|
5
|
Graham I, Shear C, De Graeff P, Boulton C, Catapano AL, Stough WG, Carlsson SC, De Backer G, Emmerich J, Greenfeder S, Kim AM, Lautsch D, Nguyen T, Nissen SE, Prasad K, Ray KK, Robinson JG, Sasiela WJ, Bruins Slot K, Stroes E, Thuren T, Van der Schueren B, Velkovski-Rouyer M, Wasserman SM, Wiklund O, Zouridakis E. New strategies for the development of lipid-lowering therapies to reduce cardiovascular risk. Eur Heart J Cardiovasc Pharmacother 2019; 4:119-127. [PMID: 29194462 DOI: 10.1093/ehjcvp/pvx031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/27/2017] [Indexed: 12/29/2022]
Abstract
The very high occurrence of cardiovascular events presents a major public health issue, because treatment remains suboptimal. Lowering LDL cholesterol (LDL-C) with statins or ezetimibe in combination with a statin reduces major adverse cardiovascular events. The cardiovascular risk reduction in relation to the absolute LDL-C reduction is linear for most interventions without evidence of attenuation or increase in risk at low LDL-C levels. Opportunities for innovation in dyslipidaemia treatment should address the substantial risk of lipid-associated cardiovascular events among patients optimally treated per guidelines but who cannot achieve LDL-C goals and who could benefit from additional LDL-C-lowering therapy or experience side effects of statins. Fresh approaches are needed to identify promising drug targets early and develop them efficiently. The Cardiovascular Round Table of the European Society of Cardiology (ESC) convened a workshop to discuss new lipid-lowering strategies for cardiovascular risk reduction. Opportunities to improve treatment approaches and the efficient study of new therapies were explored. Circulating biomarkers may not be fully reliable proxy indicators of the relationship between treatment effect and clinical outcome. Mendelian randomization studies may better inform development strategies and refine treatment targets before Phase 3. Trials should match the drug to appropriate lipid and patient profile, and guidelines may move towards a precision-based approach to individual patient management. Stakeholder collaboration is needed to ensure continued innovation and better international coordination of both regulatory aspects and guidelines. It should be noted that risk may also be addressed through increased attention to other risk factors such as smoking, hypertension, overweight, and inactivity.
Collapse
Affiliation(s)
- Ian Graham
- Trinity College, Adelaide Health Foundation, Tallaght Hospital, Dublin 24, Ireland
| | - Chuck Shear
- Global Product Development/Internal Medicine, Pfizer, Inc., 235 E. 42nd Street, New York, New York 10017, NY, USA
| | - Pieter De Graeff
- Dutch Medicines Evaluation Board (CBG-MEB), Graadt Van Roggenweg 500, 3531 AH Utrecht, The Netherlands.,Department of Pharmacy and Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences and Multimedica IRCCS, University of Milan, via Balzaretti 9, 20133 Milano, Italy
| | - Wendy Gattis Stough
- Departments of Clinical Research and Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, 217 Main St., Buies Creek, NC 27506, USA
| | - Stefan C Carlsson
- Cardiovascular Pharmacology, AstraZeneca, Pepparredsleden 1, SE-431 83 Mölndal, Sweden
| | - Guy De Backer
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, University Hospital, K3, 4th floor, De Pintelaan 185, B9000 Ghent, Belgium
| | - Joseph Emmerich
- Université Paris-Descartes, Cochin-Hôtel Dieu Hospital, French National Agency for Medicines and Health Products Safety, 143/147, Boulevard, Anatole France 93285, Saint-Denis, France
| | - Scott Greenfeder
- Regulatory Affairs, Daiichi-Sankyo, 211 Mt. Airy Road, Basking Ridge, NJ 07920, USA
| | - Albert M Kim
- Internal Medicine Research Unit, Pfizer, Inc., 1 Portland St., 4th floor, Cambridge, MA 02139, USA
| | - Dominik Lautsch
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Tu Nguyen
- Sanofi, 55 Corporate Drive, Bridgewater, NJ, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Krishna Prasad
- Licensing Division, United Kingdom Medicines and Healthcare Products Regulatory Agency, 151 Buckingham Palace Road, London SW1W 9SZ, UK
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College, 323 Reynolds Building, Room 320, Charing Cross Hospital, London W68RF, UK
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, University of Iowa, 145 N. Riverside Dr S455 CPHB, Iowa City, IA 52242, USA
| | - William J Sasiela
- Regeneron Pharmaceuticals, 777 Old Saw Mill River Road, Tarrytown, NY 10591, USA
| | - Karsten Bruins Slot
- Oslo University Hospital, Ullevål, Medical Department, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Erik Stroes
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tom Thuren
- Novartis Pharma AG, Asklepios 8, 4056 Basel, Switzerland
| | - Bart Van der Schueren
- Laboratory of Experimental Medicine and Endocrinology, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | - Scott M Wasserman
- Amgen, One Amgen Center Drive, MS 38.2.C, Thousand Oaks, CA 91320, USA
| | - Olov Wiklund
- Wallenberg Laboratory, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Emmanouil Zouridakis
- Licensing Division, United Kingdom Medicines and Healthcare Products Regulatory Agency, 151 Buckingham Palace Road, London SW1W 9SZ, UK
| | | |
Collapse
|
6
|
Bass A, Plotka A, Mridha K, Sattler C, Kim AM, Plowchalk DR. Pharmacokinetics, pharmacodynamics, and safety of bococizumab, a monoclonal antibody against proprotein convertase subtilisin/kexin type 9, in healthy subjects when administered in co-mixture with recombinant human hyaluronidase: A phase 1 randomized trial. Health Sci Rep 2018; 1:e61. [PMID: 30623096 PMCID: PMC6266420 DOI: 10.1002/hsr2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/03/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
AIM Prior to the discontinuation of bococizumab's clinical development, it was considered advantageous to develop an infrequent dosing regimen (eg, monthly). Therefore, we conducted a phase 1 study to evaluate the pharmacokinetics, pharmacodynamics, and safety of bococizumab when administered in co-mixture with recombinant human hyaluronidase (rHuPH20). METHOD Healthy subjects (N = 60) were randomized equally among 4 groups that received a single subcutaneous dose of either bococizumab 150, 300, or 450 mg co-mixed with rHuPH20 or bococizumab 300 mg alone. Bioavailability and lipid-lowering effect of bococizumab were evaluated by using ANCOVA models. RESULTS In the groups administered bococizumab co-mixed with rHuPH20, dose-normalized C max and AUCinf were 26.6 to 39.1% and 18.3 to 36.6% greater, respectively, compared with bococizumab 300 mg alone. Despite these increases, mean percent reductions from baseline in low-density lipoprotein cholesterol were smaller in the bococizumab 300 mg + rHuPH20 group than in the bococizumab 300-mg group at Day 21 (52.2% and 59.5%, respectively) and were similar at Day 29 (51.7% and 49.6%, respectively). Compared with the group administered bococizumab 300 mg alone, the bococizumab 300 mg + rHuPH20 group did not show a significantly altered AUEC85 (ratio of adjusted means: 102.5%, 90% confidence interval: 96.1-109.3%) but did show a higher MaxELDL-C (ratio of adjusted means: 125.4%, 90% confidence interval: 103.3-152.2%), indicating diminution of efficacy. The most frequent adverse events were injection-site erythema, injection-site bruising, and nasopharyngitis; all injection-site adverse events were mild. CONCLUSION Co-mixture with rHuPH20 increased the bioavailability of bococizumab without proportional increase in pharmacodynamic effect. TRIAL REGISTRATION ClinicalTrials.gov, NCT02667223.
Collapse
Affiliation(s)
- Almasa Bass
- Pfizer Global Product DevelopmentDurhamNCUSA
| | - Anna Plotka
- Pfizer Worldwide Research & DevelopmentCollegevillePAUSA
| | | | | | - Albert M. Kim
- Pfizer Internal Medicine Research UnitCambridgeMAUSA
| | | |
Collapse
|
7
|
Kim AM, Somayaji VR, Dong JQ, Rolph TP, Weng Y, Chabot JR, Gropp KE, Talukdar S, Calle RA. Once-weekly administration of a long-acting fibroblast growth factor 21 analogue modulates lipids, bone turnover markers, blood pressure and body weight differently in obese people with hypertriglyceridaemia and in non-human primates. Diabetes Obes Metab 2017; 19:1762-1772. [PMID: 28573777 DOI: 10.1111/dom.13023] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 01/08/2023]
Abstract
AIMS To assess the safety, tolerability, pharmacokinetics and pharmacodynamics of PF-05231023, a long-acting fibroblast growth factor 21 (FGF21) analogue, in obese people with hypertriglyceridaemia on atorvastatin, with or without type 2 diabetes. METHODS Participants received PF-05231023 or placebo intravenously once weekly for 4 weeks. Safety (12-lead ECGs, vital signs, adverse events [AEs], laboratory tests) and longitudinal weight assessments were performed. Blood samples were collected for pharmacokinetic and pharmacodynamic analyses. Cardiovascular safety studies were also conducted in telemetered rats and monkeys. Blood pressure (BP; mean, systolic and diastolic) and ECGs were monitored. RESULTS A total of 107 people were randomized. PF-05231023 significantly decreased mean placebo-adjusted fasting triglycerides (day 25, 33%-43%) and increased HDL cholesterol (day 25, 15.7%-28.6%) and adiponectin (day 25, 1574 to 3272 ng/mL) across all doses, without significant changes in body weight (day 25, -0.45% to -1.21%). Modest decreases from baseline were observed for N-terminal propeptides of type 1 collagen (P1NP) on day 25, although C-telopeptide cross-linking of type 1 collagen (CTX-1) increased minimally. Systolic, diastolic BP, and pulse rate increased in a dose- and time-related manner. There were 5 serious AEs (one treatment-related) and no deaths. Three participants discontinued because of AEs. The majority of AEs were gastrointestinal. PF-05231023 increased BP and heart rate in rats, but not in monkeys. CONCLUSIONS Once-weekly PF-05231023 lowered triglycerides markedly in the absence of weight loss, with modest changes in markers of bone homeostasis. This is the first report showing increases in BP and pulse rate in humans and rats after pharmacological administration of a long-acting FGF21 molecule.
Collapse
MESH Headings
- Animals
- Anti-Obesity Agents/administration & dosage
- Anti-Obesity Agents/adverse effects
- Anti-Obesity Agents/pharmacokinetics
- Anti-Obesity Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Biomarkers/blood
- Body Mass Index
- Bone Remodeling/drug effects
- Delayed-Action Preparations/administration & dosage
- Delayed-Action Preparations/adverse effects
- Delayed-Action Preparations/pharmacokinetics
- Delayed-Action Preparations/therapeutic use
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Administration Schedule
- Drug Resistance
- Female
- Fibroblast Growth Factors/administration & dosage
- Fibroblast Growth Factors/adverse effects
- Fibroblast Growth Factors/pharmacokinetics
- Fibroblast Growth Factors/therapeutic use
- Follow-Up Studies
- Half-Life
- Humans
- Hypertension/chemically induced
- Hypertension/physiopathology
- Hypertriglyceridemia/blood
- Hypertriglyceridemia/complications
- Hypertriglyceridemia/drug therapy
- Hypolipidemic Agents/administration & dosage
- Hypolipidemic Agents/adverse effects
- Hypolipidemic Agents/pharmacokinetics
- Hypolipidemic Agents/therapeutic use
- Infusions, Intravenous
- Male
- Middle Aged
- Obesity/blood
- Obesity/complications
- Obesity/drug therapy
- Severity of Illness Index
- Species Specificity
Collapse
Affiliation(s)
| | | | | | | | - Yan Weng
- Pfizer Inc., Cambridge, Massachusetts, USA
| | | | | | | | | |
Collapse
|
8
|
Ridker PM, Tardif JC, Amarenco P, Duggan W, Glynn RJ, Jukema JW, Kastelein JJP, Kim AM, Koenig W, Nissen S, Revkin J, Rose LM, Santos RD, Schwartz PF, Shear CL, Yunis C. Lipid-Reduction Variability and Antidrug-Antibody Formation with Bococizumab. N Engl J Med 2017; 376:1517-1526. [PMID: 28304227 DOI: 10.1056/nejmoa1614062] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bococizumab, a humanized monoclonal antibody targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), reduces levels of low-density lipoprotein (LDL) cholesterol. However, the variability and durability of this effect are uncertain. METHODS We conducted six parallel, multinational lipid-lowering trials enrolling 4300 patients with hyperlipidemia who were randomly assigned to receive 150 mg of bococizumab or placebo subcutaneously every 2 weeks and who were followed for up to 12 months; 96% were receiving statin therapy at the time of enrollment. The patients were assessed for lipid changes over time, stratified according to the presence or absence of antidrug antibodies detected during the treatment period. RESULTS At 12 weeks, patients who received bococizumab had a reduction of 54.2% in the LDL cholesterol level from baseline, as compared with an increase of 1.0% among those who received placebo (absolute between-group difference, -55.2 percentage points). Significant between-group differences were also observed in total cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (P<0.001 for all comparisons). However, high-titer antidrug antibodies developed in a substantial proportion of the patients who received bococizumab, which markedly diminished the magnitude and durability of the reduction in LDL cholesterol levels. In addition, among patients with no antidrug antibodies, there was wide variability in the reduction in LDL cholesterol levels at both 12 weeks and 52 weeks. Major cardiovascular events occurred in 57 patients (2.5%) who received bococizumab and in 55 (2.7%) who received placebo (hazard ratio, 0.96; 95% confidence interval, 0.66 to 1.39; P=0.83). The most common adverse event among patients who received bococizumab was injection-site reaction (12.7 per 100 person-years). CONCLUSIONS In six multinational trials evaluating bococizumab, antidrug antibodies developed in a large proportion of the patients and significantly attenuated the lowering of LDL cholesterol levels. Wide variation in the relative reduction in cholesterol levels was also observed among patients in whom antidrug antibodies did not develop. (Funded by Pfizer; SPIRE ClinicalTrials.gov numbers, NCT01968954 , NCT01968967 , NCT01968980 , NCT02100514 , NCT02135029 , and NCT02458287 .).
Collapse
Affiliation(s)
- Paul M Ridker
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Jean-Claude Tardif
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Pierre Amarenco
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - William Duggan
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Robert J Glynn
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - J Wouter Jukema
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - John J P Kastelein
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Albert M Kim
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Wolfgang Koenig
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Steven Nissen
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - James Revkin
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Lynda M Rose
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Raul D Santos
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Pamela F Schwartz
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Charles L Shear
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| | - Carla Yunis
- From Brigham and Women's Hospital, Harvard Medical School, Boston (P.M.R., R.J.G., L.M.R.); Montreal Heart Institute, Université de Montréal, Montreal (J.-C.T.); Pierre et Marie Curie University, Paris (P.A.); Pfizer, New York (W.D., A.M.K., J.R., P.F.S., C.L.S., C.Y.); Leiden University Medical Center, Leiden (J.W.J.), and Academic Medical Center of the University of Amsterdam, Amsterdam (J.J.P.K.) - both in the Netherlands; Deutsches Herzzentrum München, Technische Universität München, DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany (W.K.); Cleveland Clinic Foundation, Cleveland (S.N.); and the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital, São Paulo (R.D.S.)
| |
Collapse
|
9
|
Cowie MR, Filippatos GS, Alonso Garcia MDLA, Anker SD, Baczynska A, Bloomfield DM, Borentain M, Bruins Slot K, Cronin M, Doevendans PA, El-Gazayerly A, Gimpelewicz C, Honarpour N, Janmohamed S, Janssen H, Kim AM, Lautsch D, Laws I, Lefkowitz M, Lopez-Sendon J, Lyon AR, Malik FI, McMurray JJV, Metra M, Figueroa Perez S, Pfeffer MA, Pocock SJ, Ponikowski P, Prasad K, Richard-Lordereau I, Roessig L, Rosano GMC, Sherman W, Stough WG, Swedberg K, Tyl B, Zannad F, Boulton C, De Graeff P. New medicinal products for chronic heart failure: advances in clinical trial design and efficacy assessment. Eur J Heart Fail 2017; 19:718-727. [PMID: 28345190 DOI: 10.1002/ejhf.809] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 12/13/2022] Open
Abstract
Despite the availability of a number of different classes of therapeutic agents with proven efficacy in heart failure, the clinical course of heart failure patients is characterized by a reduction in life expectancy, a progressive decline in health-related quality of life and functional status, as well as a high risk of hospitalization. New approaches are needed to address the unmet medical needs of this patient population. The European Medicines Agency (EMA) is undertaking a revision of its Guideline on Clinical Investigation of Medicinal Products for the Treatment of Chronic Heart Failure. The draft version of the Guideline was released for public consultation in January 2016. The Cardiovascular Round Table of the European Society of Cardiology (ESC), in partnership with the Heart Failure Association of the ESC, convened a dedicated two-day workshop to discuss three main topic areas of major interest in the field and addressed in this draft EMA guideline: (i) assessment of efficacy (i.e. endpoint selection and statistical analysis); (ii) clinical trial design (i.e. issues pertaining to patient population, optimal medical therapy, run-in period); and (iii) research approaches for testing novel therapeutic principles (i.e. cell therapy). This paper summarizes the key outputs from the workshop, reviews areas of expert consensus, and identifies gaps that require further research or discussion. Collaboration between regulators, industry, clinical trialists, cardiologists, health technology assessment bodies, payers, and patient organizations is critical to address the ongoing challenge of heart failure and to ensure the development and market access of new therapeutics in a scientifically robust, practical and safe way.
Collapse
Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK
| | - Gerasimos S Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Maria de Los Angeles Alonso Garcia
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK.,Scientific Advice Working Party European Medicines Agency, Medical Assessor Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany.,Division of Homeostasis Research, Dept of Cardiology, Charité Campus CVK, Berlin, Germany
| | | | | | | | | | | | - Pieter A Doevendans
- European Medicines Agency Committee for Advanced Therapy, London, UK.,UMC, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Martin Lefkowitz
- Novartis Pharmaceuticals, East Hanover, New Jersey, United States
| | - Jose Lopez-Sendon
- Cardiology Department, Hospital Universitario La Paz; IdiPaz, CIBER-CV, Madrid, Spain
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK
| | | | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | - Marco Metra
- Cardiology, University of Brescia, Brescia, Italy
| | | | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | - Krishna Prasad
- United Kingdom Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Giuseppe M C Rosano
- IRCCS San Raffaele Hospital Roma, Rome, Italy.,Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust, University of London, London, UK
| | | | | | - Karl Swedberg
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, Sydney Street, London, SW3 6HP, UK.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Faiez Zannad
- INSERM, Centre d'Investigation Clinique 1433 and Unité 1116, Université de Lorraine and CHU, Nancy, France
| | | | - Pieter De Graeff
- Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| |
Collapse
|
10
|
Anker SD, Schroeder S, Atar D, Bax JJ, Ceconi C, Cowie MR, Crisp A, Dominjon F, Ford I, Ghofrani HA, Gropper S, Hindricks G, Hlatky MA, Holcomb R, Honarpour N, Jukema JW, Kim AM, Kunz M, Lefkowitz M, Floch CL, Landmesser U, McDonagh TA, McMurray JJ, Merkely B, Packer M, Prasad K, Revkin J, Rosano GMC, Somaratne R, Stough WG, Voors AA, Ruschitzka F. Erratum to "Traditional and new composite endpoints in heart failure clinical trials: facilitating comprehensive efficacy assessments and improving trial efficiency" [Eur J Heart Fail 2016;18:482-489]. Eur J Heart Fail 2016; 18:727. [PMID: 27324688 DOI: 10.1002/ejhf.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Germany
| | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ulleval and University of Oslo, Norway
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claudio Ceconi
- Unit of Cardiology, Hospital of Desenzano del Garda, Desenzano del Garda, Italy
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, UGMLC [member of the German Center for Lung Research (DZL)], Giessen, Germany.,Kerckhoff-Klinik Bad Nauheim, Germany.,Imperial College London, UK
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Mark A Hlatky
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - John J McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Milton Packer
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Krishna Prasad
- United Kingdom Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | - Giuseppe M C Rosano
- IRCCS San Raffaele Hospital Roma, Rome, Italy.,Cardiovascular and Cell Sciences Institute, St. George's University of London, London, UK
| | | | | | | | - Frank Ruschitzka
- Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Anker SD, Schroeder S, Atar D, Bax JJ, Ceconi C, Cowie MR, Crisp A, Dominjon F, Ford I, Ghofrani HA, Gropper S, Hindricks G, Hlatky MA, Holcomb R, Honarpour N, Jukema JW, Kim AM, Kunz M, Lefkowitz M, Le Floch C, Landmesser U, McDonagh TA, McMurray JJ, Merkely B, Packer M, Prasad K, Revkin J, Rosano GMC, Somaratne R, Stough WG, Voors AA, Ruschitzka F. Traditional and new composite endpoints in heart failure clinical trials: facilitating comprehensive efficacy assessments and improving trial efficiency. Eur J Heart Fail 2016; 18:482-9. [PMID: 27071916 DOI: 10.1002/ejhf.516] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/15/2015] [Accepted: 01/17/2016] [Indexed: 02/05/2023] Open
Abstract
Composite endpoints are commonly used as the primary measure of efficacy in heart failure clinical trials to assess the overall treatment effect and to increase the efficiency of trials. Clinical trials still must enrol large numbers of patients to accrue a sufficient number of outcome events and have adequate power to draw conclusions about the efficacy and safety of new treatments for heart failure. Additionally, the societal and health system perspectives on heart failure have raised interest in ascertaining the effects of therapy on outcomes such as repeat hospitalization and the patient's burden of disease. Thus, novel methods for using composite endpoints in clinical trials (e.g. clinical status composite endpoints, recurrent event analyses) are being applied in current and planned trials. Endpoints that measure functional status or reflect the patient experience are important but used cautiously because heart failure treatments may improve function yet have adverse effects on mortality. This paper discusses the use of traditional and new composite endpoints, identifies qualities of robust composites, and outlines opportunities for future research.
Collapse
Affiliation(s)
- Stefan D Anker
- Innovative Clinical Trials, Depar tment of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Germany
| | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ulleval and University of Oslo, Norway
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Claudio Ceconi
- Unit of Cardiology, Hospital of Desenzano del Garda, Desenzano del Garda, Italy
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, UGMLC [member of the German Center for Lung Research (DZL)], Giessen, Germany.,Kerckhoff-Klinik Bad Nauheim, Germany.,Imperial College London, UK
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Mark A Hlatky
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - John J McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Milton Packer
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Krishna Prasad
- United Kingdom Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | - Giuseppe M C Rosano
- IRCCS San Raffaele Hospital Roma, Rome, Italy.,Cardiovascular and Cell Sciences Institute, St. George's University of London, London, UK
| | | | | | | | - Frank Ruschitzka
- Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Center Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Kong BY, Duncan FE, Que EL, Kim AM, O'Halloran TV, Woodruff TK. Maternally-derived zinc transporters ZIP6 and ZIP10 drive the mammalian oocyte-to-egg transition. Mol Hum Reprod 2014; 20:1077-89. [PMID: 25143461 DOI: 10.1093/molehr/gau066] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rapid cellular zinc influx regulates early mammalian development during the oocyte-to-egg transition through modulation of the meiotic cell cycle. Despite the physiological necessity of this zinc influx, the molecular mechanisms that govern such accumulation are unknown. Here we show that the fully grown mammalian oocyte does not employ a transcriptionally based mechanism of zinc regulation involving metal response element-binding transcription factor-1 (MTF-1), as demonstrated by a lack of MTF-1 responsiveness to environmental zinc manipulation. Instead, the mammalian oocyte controls zinc uptake through two maternally derived and cortically distributed zinc transporters, ZIP6 and ZIP10. Targeted disruption of these transporters using several approaches during meiotic maturation perturbs the intracellular zinc quota and results in a cell cycle arrest at a telophase I-like state. This arrest phenocopies established models of zinc insufficiency during the oocyte-to-egg transition, indicating the essential function of these maternally expressed transporters. Labile zinc localizes to punctate cytoplasmic structures in the human oocyte, and ZIP6 and ZIP10 are enriched in the cortex. Altogether, we demonstrate a mechanism of metal regulation required for female gamete development that may be evolutionarily conserved.
Collapse
Affiliation(s)
- B Y Kong
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, 250 East Superior Street, Suite 3-2303, Chicago, IL 60611, USA
| | - F E Duncan
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, 250 East Superior Street, Suite 3-2303, Chicago, IL 60611, USA
| | - E L Que
- The Chemistry of Life Processes Institute and Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
| | - A M Kim
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, 250 East Superior Street, Suite 3-2303, Chicago, IL 60611, USA
| | - T V O'Halloran
- The Chemistry of Life Processes Institute and Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA Department of Molecular Biosciences, Northwestern University, 2205 Tech Drive, Hogan 2-100, Evanston, IL 60208, USA
| | - T K Woodruff
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, 250 East Superior Street, Suite 3-2303, Chicago, IL 60611, USA Department of Molecular Biosciences, Northwestern University, 2205 Tech Drive, Hogan 2-100, Evanston, IL 60208, USA
| |
Collapse
|
13
|
Wu JS, Kim AM, Bleher R, Myers BD, Marvin RG, Inada H, Nakamura K, Zhang XF, Roth E, Li SY, Woodruff TK, O'Halloran TV, Dravid VP. Imaging and elemental mapping of biological specimens with a dual-EDS dedicated scanning transmission electron microscope. Ultramicroscopy 2013; 128:24-31. [PMID: 23500508 DOI: 10.1016/j.ultramic.2013.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Abstract
A dedicated analytical scanning transmission electron microscope (STEM) with dual energy dispersive spectroscopy (EDS) detectors has been designed for complementary high performance imaging as well as high sensitivity elemental analysis and mapping of biological structures. The performance of this new design, based on a Hitachi HD-2300A model, was evaluated using a variety of biological specimens. With three imaging detectors, both the surface and internal structure of cells can be examined simultaneously. The whole-cell elemental mapping, especially of heavier metal species that have low cross-section for electron energy loss spectroscopy (EELS), can be faithfully obtained. Optimization of STEM imaging conditions is applied to thick sections as well as thin sections of biological cells under low-dose conditions at room and cryogenic temperatures. Such multimodal capabilities applied to soft/biological structures usher a new era for analytical studies in biological systems.
Collapse
Affiliation(s)
- J S Wu
- Northwestern University Atomic and Nanoscale Characterization Experimental (NUANCE) Center, Northwestern University, Evanston, IL 60208, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Erdemli G, Kim AM, Ju H, Springer C, Penland RC, Hoffmann PK. Cardiac Safety Implications of hNav1.5 Blockade and a Framework for Pre-Clinical Evaluation. Front Pharmacol 2012; 3:6. [PMID: 22303294 PMCID: PMC3266668 DOI: 10.3389/fphar.2012.00006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/12/2012] [Indexed: 12/17/2022] Open
Abstract
The human cardiac sodium channel (hNav1.5, encoded by the SCN5A gene) is critical for action potential generation and propagation in the heart. Drug-induced sodium channel inhibition decreases the rate of cardiomyocyte depolarization and consequently conduction velocity and can have serious implications for cardiac safety. Genetic mutations in hNav1.5 have also been linked to a number of cardiac diseases. Therefore, off-target hNav1.5 inhibition may be considered a risk marker for a drug candidate. Given the potential safety implications for patients and the costs of late stage drug development, detection, and mitigation of hNav1.5 liabilities early in drug discovery and development becomes important. In this review, we describe a pre-clinical strategy to identify hNav1.5 liabilities that incorporates in vitro, in vivo, and in silico techniques and the application of this information in the integrated risk assessment at different stages of drug discovery and development.
Collapse
Affiliation(s)
- Gül Erdemli
- Center for Proteomic Chemistry, Novartis Institutes for Biomedical Research Cambridge, MA, USA
| | | | | | | | | | | |
Collapse
|
15
|
Kanaev AV, Daniel BJ, Neumann JG, Kim AM, Lee KR. Object level HSI-LIDAR data fusion for automated detection of difficult targets. Opt Express 2011; 19:20916-20929. [PMID: 21997101 DOI: 10.1364/oe.19.020916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Data fusion from disparate sensors significantly improves automated man-made target detection performance compared to that of just an individual sensor. In particular, it can solve hyperspectral imagery (HSI) detection problems pertaining to low-radiance man-made objects and objects in shadows. We present an algorithm that fuses HSI and LIDAR data for automated detection of man-made objects. LIDAR is used to define a set of potential targets based on physical dimensions, and HSI is then used to discriminate between man-made and natural objects. The discrimination technique is a novel HSI detection concept that uses an HSI detection score localization metric capable of distinguishing between wide-area score distributions inherent to natural objects and highly localized score distributions indicative of man-made targets. A typical man-made localization score was found to be around 0.5 compared to natural background typical localization scores being less than 0.1.
Collapse
Affiliation(s)
- A V Kanaev
- Naval Research Laboratory, 4555 Overlook Avenue, Washington, DC 20375, USA
| | | | | | | | | |
Collapse
|
16
|
Abstract
Cells in the Purkinje system (PS) are known to be more vulnerable than ventricular myocytes to secondary excitations during the action potential (AP) plateau or repolarization phases, known as early afterdepolarizations (EADs). Since myocytes have a lower intrinsic AP duration than the PS cells to which they are coupled, EADs occurring in distal branches of the PS are more likely to result in propagating ectopic beats. In this study, we use a computer model of the rabbit ventricles and PS to investigate the consequences of EADs occurring at different times and places in the cardiac conduction system. We quantify the role of tissue conductivity and excitability, as well as interaction with sinus excitation, in determining whether an EAD-induced ectopic beat will establish reentrant activity. We demonstrate how a single ectopic beat arising from an EAD in the distal PS can give rise to reentrant arrhythmia; in contrast, EADs in the proximal PS were unable to initiate reentry. Clinical studies have established the PS as a potential substrate for reentry, but the underlying mechanisms of these types of disorder are not well understood, nor are conditions leading to their development clearly defined; this work provides new insights into the role of the PS in such circumstances. Our findings indicate that simulated EADs in the distal PS can induce premature beats, which can lead to the tachycardias involving the conduction system due to interactions with sinus activity or impaired myocardial conduction velocity.
Collapse
Affiliation(s)
- Makarand Deo
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | |
Collapse
|
17
|
Yang Y, Varma N, Badhwar N, Tanel RE, Sundara S, Lee RJ, Lee BK, Tseng ZH, Marcus GM, Kim AM, Olgin JE, Scheinman MM. Prospective observations in the clinical and electrophysiological characteristics of intra-isthmus reentry. J Cardiovasc Electrophysiol 2010; 21:1099-106. [PMID: 20455984 DOI: 10.1111/j.1540-8167.2010.01778.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Intra-isthmus reentry (IIR) is a circuit within the cavotricuspid isthmus (CTI). The purpose of this study is to prospectively define the electrogram and surface ECG characteristics of IIR, and its clinical implications. METHODS AND RESULTS Fourteen patients underwent electrophysiological studies and were found to have IIR. Detailed electrogram mapping of the CTI was available in all, electroanatomic mapping (EAM) in 8 of 14 (57%) patients. In all, entrainment mapping during tachycardia proved reentry, and showed that the anteroinferior CTI was out of the circuit and the septal CTI was in the circuit in 12 of 14 patients, whereas in 2, the circuit was confined within the mid and/or anteroinferior CTI. Fractionated potentials (FPs) spanning 34-71% of the tachycardia cycle length were recorded within the CTI in all, and double potentials were inscribed in 10 of 14 (71%). Analysis of the tricuspid annulus electrograms showed spontaneous shifts from a counterclockwise (CCW) to clockwise or fusion patterns. Surface ECGs showed either typical CCW pattern (12 patients) or atypical patterns (3 patients). The EAMs showed a focal pattern in 3, a CCW pattern in 5. The successful ablation site always occurred at the area with maximal FP duration. Over the same period, 33 of 384 (9%) patients who underwent ablation for CTI-dependent flutter had prior successful CTI ablation, 7 of 33 (21%) were found to have IIR during the redo procedure. CONCLUSIONS (1) Electrogram and ECG patterns of IIR frequently show atypical flutter. (2) IIR was successfully ablated in an area of the CTI associated with maximal duration of FPs. (3) IIR is a significant cause of "recurrent flutter" in patients with prior CTI ablation.
Collapse
Affiliation(s)
- Yanfei Yang
- University of California-San Francisco, San Francisco, California 94143-1354, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Marcus GM, Smith LM, Ordovas K, Scheinman MM, Kim AM, Badhwar N, Lee RJ, Tseng ZH, Lee BK, Olgin JE. Intracardiac and extracardiac markers of inflammation during atrial fibrillation. Heart Rhythm 2009; 7:149-54. [PMID: 20022819 DOI: 10.1016/j.hrthm.2009.10.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND A decrease in inflammation after cure of atrial arrhythmias suggests that such arrhythmias are proinflammatory, and lower inflammatory marker levels in the coronary sinus suggest that atrial arrhythmias result in intracardiac appropriation of inflammatory cytokines. OBJECTIVE The purpose of this study was to investigate the effect of atrial fibrillation on inflammatory markers drawn from intracardiac and extracardiac chambers. METHODS We performed a case-control study of 167 AF patients and 207 controls. Blood from intracardiac and extracardiac sites was obtained from a subset of patients undergoing curative AF ablation (n = 46). RESULTS No significant differences in C-reactive protein (CRP) or interleukin-6 (IL-6) levels were seen between patients with and those without a history of AF. Both levels were significantly higher when blood was drawn during AF than during sinus rhythm: median CRP 3.1 mg/dL (interquartile range [IQR] 1.0-6.0) versus 1.7 mg/dL (IQR 0.7-3.9, P = .0005); median IL-6 2.3 ng/mL (IQR 1.5-3.9) versus 1.5 ng/mL (IQR 0.7-2.5, P = .007). This finding persisted after adjusting for potential confounders. AF ablation patients in AF exhibited a positive median left atrial minus coronary sinus gradient CRP (0.3 mg/dL, IQR -0.03-1.1), whereas those in sinus rhythm had a negative median left atrial minus coronary sinus gradient CRP (-0.2, IQR -0.8-[-0.02], P = .01). Femoral artery minus femoral vein gradients in AF versus sinus rhythm did not show any differences. CONCLUSION AF at the time of the blood draw, rather than a history of AF, was independently associated with inflammation. Differences in transcardiac gradients suggest that AF results in sequestration of inflammatory cytokines in the heart.
Collapse
Affiliation(s)
- Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, CA, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Milan DJ, Kim AM, Winterfield JR, Jones IL, Pfeufer A, Sanna S, Arking DE, Amsterdam AH, Sabeh KM, Mably JD, Rosenbaum DS, Peterson RT, Chakravarti A, Kääb S, Roden DM, MacRae CA. Drug-sensitized zebrafish screen identifies multiple genes, including GINS3, as regulators of myocardial repolarization. Circulation 2009; 120:553-9. [PMID: 19652097 DOI: 10.1161/circulationaha.108.821082] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac repolarization, the process by which cardiomyocytes return to their resting potential after each beat, is a highly regulated process that is critical for heart rhythm stability. Perturbations of cardiac repolarization increase the risk for life-threatening arrhythmias and sudden cardiac death. Although genetic studies of familial long-QT syndromes have uncovered several key genes in cardiac repolarization, the major heritable contribution to this trait remains unexplained. Identification of additional genes may lead to a better understanding of the underlying biology, aid in identification of patients at risk for sudden death, and potentially enable new treatments for susceptible individuals. METHODS AND RESULTS We extended and refined a zebrafish model of cardiac repolarization by using fluorescent reporters of transmembrane potential. We then conducted a drug-sensitized genetic screen in zebrafish, identifying 15 genes, including GINS3, that affect cardiac repolarization. Testing these genes for human relevance in 2 concurrently completed genome-wide association studies revealed that the human GINS3 ortholog is located in the 16q21 locus, which is strongly associated with QT interval. CONCLUSIONS This sensitized zebrafish screen identified 15 novel myocardial repolarization genes. Among these genes is GINS3, the human ortholog of which is a major locus in 2 concurrent human genome-wide association studies of QT interval. These results reveal a novel network of genes that regulate cardiac repolarization.
Collapse
Affiliation(s)
- David J Milan
- Cardiovascular Research Center, and Cardiology Division, Massachusetts General Hospital, Boston, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
|
22
|
Abstract
We report a case of a 45-year-old man with incessant supraventricular tachycardia (SVT) in the setting of intrahepatic inferior vena cava thrombus and a left upper extremity arteriovenous fistula. A diagnostic electrophysiology study (EPS) was performed via the right internal jugular and right subclavian veins. After confirming the mechanism of SVT was atrial tachycardia (AT), mapping, and successful ablation was performed using remote catheter navigation. This case demonstrates that remote navigation can facilitate the therapy of complex arrhythmias in challenging clinical situations.
Collapse
Affiliation(s)
- Albert M Kim
- UCSF Cardiac Electrophysiology, San Francisco, California 94143, USA.
| | | | | |
Collapse
|
23
|
Kim AM, Goldschlager N. Pseudoventricular fibrillation. J Electrocardiol 2008; 41:229. [DOI: 10.1016/j.jelectrocard.2008.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
24
|
Kim AM, Goldschlager N. Bradycardia. J Electrocardiol 2008; 41:206. [DOI: 10.1016/j.jelectrocard.2008.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
|
26
|
Kim AM, Milan DJ, Giokas AC, Burns CG, Macrae CA. AB37-3. Heart Rhythm 2006. [DOI: 10.1016/j.hrthm.2006.02.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
27
|
Boesewetter DE, Collier JL, Kim AM, Riley MR. Alterations of A549 lung cell gene expression in response to biochemical toxins. Cell Biol Toxicol 2006; 22:101-18. [PMID: 16528450 DOI: 10.1007/s10565-006-0150-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 11/22/2005] [Indexed: 11/29/2022]
Abstract
Health risks associated with the inhalation of potentially toxic materials have been a topic of great public concern. In vitro cellular analyses can provide mechanistic information on the molecular-level responses of lung-derived cell lines to a variety of these hazards. This understanding may be used to develop methods to reduce the damage from such toxins or to detect early stages of their effects. Here we describe an evaluation of the alterations in gene expression of an immortalized lung cell line (A549, human type II epithelia) to a variety of inhalation health hazards including etoposide, gliotoxin, streptolysin O, methyl methansesulfonate (MMS), and Triton X-100. The A549 cells display a dose-response relationship to each toxin with initial responses including alterations in metabolic activity, increases in membrane permeability, and initiation of response genes. In general, membrane-damaging agents (streptolysin O and Triton X-100) induce production of new ion channel proteins, structural proteins, and metabolic enzymes. Gliotoxin impacted the metabolic machinery, but also altered ion channels. Etoposide and MMS caused alterations in the cell cycle, induced DNA repair enzymes, and initiated apoptotic pathways, but MMS also induced immune response cascades. The mechanism of cell response to each toxin is supported by physiological analyses that indicated a fairly slow initiation of cell response to all compounds tested, except for Triton, which caused rapid decline in cell function due to solubilization of the cell membrane. However, Triton does induce production of a number of cell membrane-associated proteins and so its effects at low concentrations are likely translated throughout the cell. Together these results indicate a broader array of cellular responses to each of the test toxins than have previously been reported.
Collapse
Affiliation(s)
- D E Boesewetter
- Department of Agricultural and Biosystems Engineering, The University of Arizona, Tucson, Arizona, USA
| | | | | | | |
Collapse
|
28
|
Callan JP, Kim AM, Roeser CA, Mazur E, Solis J, Siegel J, Afonso CN, de Sande JC. Ultrafast laser-induced phase transitions in amorphous GeSb films. Phys Rev Lett 2001; 86:3650-3653. [PMID: 11328045 DOI: 10.1103/physrevlett.86.3650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2000] [Indexed: 05/23/2023]
Abstract
Time-resolved measurements of the spectral dielectric function reveal new information about ultrafast phase transitions induced by femtosecond laser pulses in Sb-rich amorphous GeSb films. The excitation generates a nonthermal phase within 200 fs. The dielectric function of this phase differs from that of the crystalline phase, contrary to previous suggestions of a disorder-to-order transition. The observed dielectric function is close to that of the liquid phase, indicating an ultrafast transition from the amorphous phase to a different disordered state.
Collapse
Affiliation(s)
- J P Callan
- Department of Physics and Division of Engineering and Applied Sciences, Gordon McKay Laboratory, Harvard University, 9 Oxford Street, Cambridge, Massachusetts 02138, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
DiFranco M, Quiñonez M, DiGregorio DA, Kim AM, Pacheco R, Vergara JL. Inverted double-gap isolation chamber for high-resolution calcium fluorimetry in skeletal muscle fibers. Pflugers Arch 1999; 438:412-8. [PMID: 10398875 DOI: 10.1007/s004240050929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Here we describe an improved inverted double-grease-gap isolation chamber that allows the formation of grease seals of high mechanical stability and high electrical resistance. We also provide a detailed description of the procedure used to mount the muscle fibers onto the apparatus. The new chamber permits the electrophysiological study of muscle fibers using an inverted microscope and high-resolution objectives, thus complying with the requirements of modern fluorescence confocal detection methods. The simplicity and reliability of the mounting procedure make this chamber preferable over other gap isolation chambers currently used for simultaneous electrophysiological and optical studies of calcium release. Experimental results obtained from amphibian muscle fibers are presented to illustrate the performance of the chamber when using global fluorescence detection, confocal spot detection, and laser confocal scanning imaging.
Collapse
Affiliation(s)
- M DiFranco
- Laboratorio de Fisiología y Biofísica del Músculo, Instituto de Biología Experimental, Facultad de Ciencias, Universidad Central de Venezuela, Caracas, Apartado 47114, Venezuela.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
In voltage-clamp studies of single frog skeletal muscle fibers stained with the potentiometric indicator 1-(3-sulfonatopropyl)-4-[beta[2-(di-n-octylamino)-6-naphthyl] vinyl]pyridinium betaine (di-8 ANEPPS), fluorescence transients were recorded in response to both supercharging and step command pulses. Several illumination paradigms were utilized to study global and localized regions of the transverse tubule system (T-system). The rising phases of transients obtained from global illumination regions showed distinct accelerations when supercharging pulses were applied (95% of steady-state fluorescence achieved in 1.5 ms with supercharging pulses versus 14.6 ms with step pulses). When local transients were recorded at the edge of the muscle fiber, their kinetics resembled those of the applied waveform, but a similar relationship was not observed in transients from regions near the edge chosen to minimize the surface membrane contribution. We developed a model of the T-system capable of simulating membrane potential changes as a function of time and distance along the T-system cable and the associated fluorescence changes in regions corresponding to the experimental illumination strategies. A critical parameter was the access resistance term, for which values of 110-150 Omega.cm2 were adequate to fit the data. The results suggest that the primary mechanism through which supercharging pulses boost the kinetics of T-system voltage changes most likely involves their compensating the voltage attenuation across the access resistance at the mouth of the T-tubule.
Collapse
Affiliation(s)
- A M Kim
- Department of Physiology, University of California at Los Angeles, Los Angeles, California 90095-1751, USA
| | | |
Collapse
|
31
|
Abstract
1. In single frog skeletal muscle fibres, we utilized supercharging voltage clamp command pulses to boost the rate of depolarization in the transverse tubular system (T-system) such that 95 % of steady-state potential is achieved in < 2 ms (as indicated by fluorescent potentiometric dye signals detected from a global illumination region). Signals detected near the edge of muscle fibres indicate that peripheral regions of the T-system are not significantly overcompensated under these conditions. 2. We explored the impact of accelerating T-system depolarization on voltage-dependent events of excitation-contraction (E-C) coupling by measuring charge movement currents (CMCs) and Ca2+ fluorescence transients in response to both supercharging and conventional step pulses. 3. When compared with CMCs elicited by step pulses, supercharging CMCs are larger, and their kinetics more closely resemble those of gating current records reported for ionic channels. Furthermore, they decay bi-exponentially (tau fast range, 1.3-1.8 ms; tau slow range, 7.3-11.9 ms), whereas step CMCs fall with a single exponential time course (tau range, 12.5-26.7 ms). 4. Similarly, supercharging produces a distinct acceleration in Ca2+ release transients, which show little evidence of the voltage-dependent onset latencies previously encountered using step pulses. 5. The use of this novel methodology in skeletal muscle unveils a previously undetected component of charge movement, the rapid, voltage-dependent recruitment of which may provide the basis for understanding the fast gating of physiological E-C coupling.
Collapse
Affiliation(s)
- A M Kim
- Department of Physiology, University of California at Los Angeles, 10833 LeConte Avenue 53-263 CHS, Los Angeles, CA 90095-1751, USA
| | | |
Collapse
|
32
|
Escobar AL, Velez P, Kim AM, Cifuentes F, Fill M, Vergara JL. Kinetic properties of DM-nitrophen and calcium indicators: rapid transient response to flash photolysis. Pflugers Arch 1997; 434:615-31. [PMID: 9242727 DOI: 10.1007/s004240050444] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a high temporal resolution confocal spot microfluorimetry setup which makes possible the detection of fluorescence transients elicited by Ca2+ indicators in response to large (50-200 microM), short duration (< 100 ns), free [Ca2+] transients generated by laser flash photolysis of DM-nitrophen (DM-n; caged Ca2+). The equilibrium and kinetic properties of the commercially available indicators Fluo-3, Rhod-2, CalciumOrange-5N (COr-5N) and CalciumGreen-2 (CGr-2) were determined experimentally. The data reveal that COr-5N displays simple, fast response kinetics while, in contrast, Fluo-3, Rhod-2 and CGr-2 are characterized by significantly slower kinetic properties. These latter indicators may be unsuitable for tracking Ca2+ signaling events lasting only a few milliseconds. A model which accurately predicts the time course of fluorescence transients in response to rapid free [Ca2+] changes was developed. Experimental data and model predictions concur only when the association rate constant of DM-n is approximately 20 times faster than previously reported. This work establishes a quantitative theoretical framework for the study of fast Ca2+ signaling events and the use of flash photolysis in cells and model systems.
Collapse
Affiliation(s)
- A L Escobar
- Department of Physiology, UCLA School of Medicine 90024, USA
| | | | | | | | | | | |
Collapse
|
33
|
Dekorsy T, Kim AM, Cho GC, Hunsche S, Bakker HJ, Kurz H, Chuang SL, Köhler K. Quantum Coherence of Continuum States in the Valence Band of GaAs Quantum Wells. Phys Rev Lett 1996; 77:3045-3048. [PMID: 10062117 DOI: 10.1103/physrevlett.77.3045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
34
|
Abstract
We describe here a single-gap isolation method that allows the simultaneous measurement of electrical activity and tension output from fully contracting segments of frog skeletal muscle fibers. By using single pulses and pulse trains of varying frequency (5-100 Hz), records obtained for both electrical and mechanical fiber response demonstrate that the physiological properties of the fiber segments have been preserved. Action potentials could be recorded free of movement artifacts, even while segments were in fused tetani and developing maximum tensions of more than 600 kN/m2. Single current pulses evoked action potentials that averaged 144 +/- 16 mV (mean +/- SD, n = 8) in amplitude and twitches that averaged 285 +/- 66 kN/m2 and 55 +/- 5 ms (mean +/- SD, n = 20) in magnitude and time to peak, respectively. Trains of action potentials elicited patterns of tension development that exhibited summation, unfused tetani, and fused tetani in a frequency-dependent manner. The AC and DC electrical properties of the single grease gap were modeled with a simple Thévenin equivalent circuit, which satisfactorily predicted the experimental results. Our methodology is easily implemented and potentially applicable to any muscle preparation in which fiber segments with an intact end attached to a piece of tendon can be dissected.
Collapse
Affiliation(s)
- A M Kim
- Department of Physiology, School of Medicine, University of California at Los Angeles 90095, USA
| | | | | |
Collapse
|
35
|
Dekorsy T, Kim AM, Cho GC, Kurz H, Kuznetsov AV, Förster A. Subpicosecond coherent carrier-phonon dynamics in semiconductor heterostructures. Phys Rev B Condens Matter 1996; 53:1531-1538. [PMID: 9983616 DOI: 10.1103/physrevb.53.1531] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
|
36
|
Yasui T, Yagura H, Komiyama M, Tamura K, Nagata Y, Fu Y, Kim AM, Nishimura S. [Management of elderly patients with aneurysmal subarachnoid hemorrhage]. No Shinkei Geka 1992; 20:651-6. [PMID: 1603271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Clinical features of 61 elderly patients aged over 70 years with ruptured intracranial aneurysms were compared with those of 328 younger patients aged under 70 years. According to a policy of early operation, elderly patients with Hunt and Kosnik's grade I, II and younger patients with grade I, II, III were operated on in the acute stage. In elderly patients with grade III, IV and younger patients with grade IV, the indication for surgery was determined case by case. Surgery was performed on 29 patients (48%) in the elderly group and 277 patients (86%) in the younger group. Our conclusions are as follows: 1. Regarding cases of grade I, II and III of Hunt and Kosnik's classification, the rate of good outcome in the elderly group was similar to that in the younger group, following early surgery and meticulous post-operative care. 2. In the elderly group, no patient in cases of grade IV obtained good surgical outcome. 3. Symptomatic vasospasm was less frequent in elderly patients (18.8%) than in younger cases (37%). 4. Delayed operation was planned for some patients in the elderly group, but none of them underwent surgery because of rerupture of aneurysms and deterioration of general condition.
Collapse
Affiliation(s)
- T Yasui
- Department of Neurosurgery, Baba Memorial Hospital
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Govindarajan S, Conrad A, Lim B, Valinluck B, Kim AM, Schmid P. Study of preneoplastic changes of liver cells by immunohistochemical and molecular hybridization techniques. Arch Pathol Lab Med 1990; 114:1042-5. [PMID: 2222145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The status of hepatitis B virus DNA was investigated by in situ hybridization in multifocal areas of a noncancerous hepatitis B virus-associated cirrhosis. This liver exhibited a marked degree of dysplasia and adenomatous hyperplasia. The results of these studies were correlated with the histopathology and immunohistochemical stains for hepatitis B core and surface antigens. There was clear evidence of a marked reduction to absence of hepatitis B viral DNA by in situ hybridization and absence of HBc and HBsAg in the foci of liver cell dysplasia and adenomatous hyperplasia. These results support the hypothesis that liver cell dysplasia and adenomatous hyperplasia are preneoplastic in nature.
Collapse
Affiliation(s)
- S Govindarajan
- Liver Unit, Rancho Los Amigos Medical Center, University of Southern California
| | | | | | | | | | | |
Collapse
|
38
|
Kim AM. [Some physical blood indices of healthy marals]. Veterinariia 1976:80. [PMID: 1021968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|