1
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Brooks S, Zuiker R, Bleys C, Ziagkos D, Moyer JA, van Nueten L, Bonaventure P, Drevets WC, van Gerven J, Salvadore G, Jacobs GE. Pharmacological characterization of the selective orexin-1 receptor antagonist JNJ-61393215 in healthy volunteers. J Psychopharmacol 2023:2698811231167989. [PMID: 37165642 DOI: 10.1177/02698811231167989] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Up to 40% of patients suffering from anxiety disorders do not benefit from currently available pharmacological treatments. Overactivity of the orexin-1 receptor (OX1R) has been implicated in anxiety- and panic-related states. AIM & METHODS We investigated the pharmacokinetics and characterized the pharmacodynamic (PD) profile of the OX1R antagonist JNJ-61393215 using a battery of central nervous system assessments investigating relevant functional domains such as alertness, attention, (visuo)motor coordination, balance, subjective effects and resting-state electroencephalography in a single ascending dose placebo-controlled study in doses from 1 to 90 mg inclusive, assessing PD up to 10 h after dosing, safety and pharmacokinetic in 48 healthy male subjects. RESULTS Average time to maximal plasma concentration (Tmax) ranged between 1.0 and 2.25 h; average half-life ranged from 13.6 to 24.6 h and average maximum plasma concentration ranged from 1.4 to 136.8 ng/mL in the 1 and 90 mg groups, respectively. JNJ-61393215 did not demonstrate any statistically significant or clinically meaningful effects on any PD endpoint at any dose investigated at Tmax nor over the total period up to 10 h post-dose and was well tolerated. The reported somnolence rate was 16.7% (which was attributable to the cohorts receiving 6 mg and higher doses) compared to 12.5% in placebo. CONCLUSION This observation is in line with our knowledge about the OX1R in preclinical studies, where only inconsistent and non-dose-dependent changes in electroencephalography or other behavioural measures were observed under non-challenged conditions, potentially exemplifying the need for a challenged subject.
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Affiliation(s)
- S Brooks
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - Rgja Zuiker
- Centre for Human Drug Research, Leiden, The Netherlands
| | - C Bleys
- Janssen Research & Development, LLC, Beerse, Belgium
| | - D Ziagkos
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J A Moyer
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - L van Nueten
- Janssen Research & Development, LLC, Beerse, Belgium
| | - P Bonaventure
- Janssen Research & Development, LLC, San Diego, CA, USA
| | - W C Drevets
- Janssen Research & Development, LLC, San Diego, CA, USA
| | - Jma van Gerven
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | - G Salvadore
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - G E Jacobs
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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2
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van Diemen MPJ, Ziagkos D, Kruizinga MD, Bénard MR, Lambrechtse P, Jansen JAJ, Snoeker BAM, Gademan MGJ, Cohen AF, Nelissen RGHH, Groeneveld GJ. Mitochondrial function, grip strength, and activity are related to recovery of mobility after a total knee arthroplasty. Clin Transl Sci 2022; 16:224-235. [PMID: 36401590 PMCID: PMC9926084 DOI: 10.1111/cts.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022] Open
Abstract
Low muscle quality and a sedentary lifestyle are indicators for a slow recovery after a total knee arthroplasty (TKA). Mitochondrial function is an important part of muscle quality and a key driver of sarcopenia. However, it is not known whether it relates to recovery. In this pilot study, we monitored activity after TKA using a wrist mounted activity tracker and assessed the relation of mitochondrial function on the rate of recovery after TKA. Additionally, we compared the increase in activity as a way to measure recovery to traditional outcome measures. Patients were studied 2 weeks before TKA and up to 6 months after. Activity was monitored continuously. Baseline mitochondrial function (citrate synthase and complex [CP] 1-5 abundance of the electron transport chain) was determined on muscle tissue taken during TKA. Traditional outcome measures (Knee Injury and Osteoarthritis Outcome Score [KOOS], timed up-and-go [TUG] completion time, grip, and quadriceps strength) were performed 2 weeks before, 6 weeks after, and 6 months after TKA. Using a multivariate regression model with various clinical baseline parameters, the following were significantly related to recovery: CP5 abundance, grip strength, and activity (regression weights 0.13, 0.02, and 2.89, respectively). During recovery, activity correlated to the KOOS-activities of daily living (ADL) score (r = 0.55, p = 0.009) and TUG completion time (r = -0.61, p = 0.001). Mitochondrial function seems to be related to recovery, but so are activity and grip strength, all indicators of sarcopenia. Using activity trackers before and after TKA might give the surgeon valuable information on the expected recovery and the opportunity to intervene if recovery is low.
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Affiliation(s)
- Marcus P. J. van Diemen
- Centre for Human Drug ResearchLeidenThe Netherlands,Department of OrthopedicsLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Menno R. Bénard
- Department of OrthopedicsAlrijne HospitalLeidenThe Netherlands
| | | | | | | | - Maaike G. J. Gademan
- Department of OrthopedicsLeiden University Medical CenterLeidenThe Netherlands,Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Adam F. Cohen
- Centre for Human Drug ResearchLeidenThe Netherlands,Department of NephrologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Geert Jan Groeneveld
- Centre for Human Drug ResearchLeidenThe Netherlands,Department of AnesthesiologyLeiden University Medical CenterLeidenThe Netherlands
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3
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Wind SS, Jansen MAA, Rijsbergen M, van Esdonk MJ, Ziagkos D, Cheng WC, Niemeyer-van der Kolk T, Korsten J, Gruszka A, Schmitz-Rohmer D, Bonnel D, Legouffe R, Barré F, Bekkenk MW, de Haas ERM, Quint KD, Rolli M, Streefkerk HJ, Burggraaf J, Vermeer MH, Rissmann R. Topical Bimiralisib Shows Meaningful Cutaneous Drug Levels in Healthy Volunteers and Mycosis Fungoides Patients but No Clinical Activity in a First-in-Human, Randomized Controlled Trial. Cancers (Basel) 2022; 14:cancers14061510. [PMID: 35326659 PMCID: PMC8946662 DOI: 10.3390/cancers14061510] [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: 12/17/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
Mycosis fungoides (MF) is a subtype of CTCL with a low incidence and high medical need for novel treatments. The objective of this randomized, placebo-controlled, double-blinded, first-in-human study was to evaluate safety, efficacy, cutaneous and systemic pharmacokinetics (PK) of topical bimiralisib in healthy volunteers (HVs) and MF patients. In this trial, a total of 6 HVs and 19 early-stage MF patients were treated with 2.0% bimiralisib gel and/or placebo. Drug efficacy was assessed by the Composite Assessment of Index Lesion Severity (CAILS) score, supported by objective measuring methods to quantify lesion severity. PK blood samples were collected frequently and cutaneous PK was investigated in skin punch biopsies on the last day of treatment. Local distribution of bimiralisib in HVs showed a mean exposure of 2.54 µg/g in the epidermis. A systemic concentration was observed after application of a target dose of 2 mg/cm2 on 400 cm2, with a mean Cavg of 0.96 ng/mL. Systemic exposure of bimiralisib was reached in all treated MF patients, and normalized plasma concentrations showed a 144% increased exposure compared to HVs, with an observed mean Cavg of 4.49 ng/mL and a mean cutaneous concentration of 5.3 µg/g. No difference in CAILS or objective lesion severity quantification upon 42 days of once-daily treatment was observed in the MF patient group. In general, the treatment was well tolerated in terms of local reactions as well as systemic adverse events. In conclusion, we showed that topical bimiralisib treatment leads to (i) meaningful cutaneous drug levels and (ii) well-tolerated systemic drug exposure in MF patients and (iii) a lack of clinical efficacy, in need of further exploration due to numerous unknown factors, before depreciation of topical bimiralisib as a novel therapeutic drug for CTCLs.
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Affiliation(s)
- Selinde S. Wind
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
| | - Manon A. A. Jansen
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Melanie Rijsbergen
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Michiel J. van Esdonk
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Wing C. Cheng
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Tessa Niemeyer-van der Kolk
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - John Korsten
- Charles River Laboratories Den Bosch B.V., 5231 DD Den Bosch, The Netherlands; (J.K.); (A.G.)
| | - Agnieszka Gruszka
- Charles River Laboratories Den Bosch B.V., 5231 DD Den Bosch, The Netherlands; (J.K.); (A.G.)
| | | | - David Bonnel
- MS Imaging Department, ImaBiotech, 59120 Lille, France; (D.B.); (R.L.); (F.B.)
| | - Raphael Legouffe
- MS Imaging Department, ImaBiotech, 59120 Lille, France; (D.B.); (R.L.); (F.B.)
| | - Florian Barré
- MS Imaging Department, ImaBiotech, 59120 Lille, France; (D.B.); (R.L.); (F.B.)
| | - Marcel W. Bekkenk
- Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | | | - Koen D. Quint
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
| | - Melanie Rolli
- PIQUR Therapeutics AG, 4057 Basel, Switzerland; (D.S.-R.); (M.R.); (H.J.S.)
| | | | - Jacobus Burggraaf
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
- Leiden Academic Centre for Drug Research, Leiden University, 2333 CC Leiden, The Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
| | - Robert Rissmann
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
- Leiden Academic Centre for Drug Research, Leiden University, 2333 CC Leiden, The Netherlands
- Correspondence:
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4
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Ruijs TQ, Heuberger JAAC, Goede AA, Ziagkos D, Otto ME, Doll RJ, Putten MJAM, Groeneveld GJ. TRANSCRANIAL MAGNETIC STIMULATION AS BIOMARKER OF EXCITABILITY IN DRUG DEVELOPMENT: A RANDOMIZED, DOUBLE‐BLIND, PLACEBO‐CONTROLLED, CROSS‐OVER STUDY. Br J Clin Pharmacol 2022; 88:2926-2937. [PMID: 35028950 PMCID: PMC9303426 DOI: 10.1111/bcp.15232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/18/2021] [Accepted: 12/22/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Titia Q. Ruijs
- Centre for Human Drug Research Leiden The Netherlands
- Leiden University Medical Center (LUMC) Leiden The Netherlands
| | | | - Annika A. Goede
- Centre for Human Drug Research Leiden The Netherlands
- University of Twente Enschede The Netherlands
| | | | | | | | | | - Geert Jan Groeneveld
- Centre for Human Drug Research Leiden The Netherlands
- Leiden University Medical Center (LUMC) Leiden The Netherlands
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5
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Jacobse J, ten Voorde W, Tandon A, Romeijn SG, Grievink HW, van der Maaden K, van Esdonk MJ, Moes DJA, Loeff F, Bloem K, de Vries A, Rispens T, Wolbink G, de Kam M, Ziagkos D, Moerland M, Jiskoot W, Bouwstra J, Burggraaf J, Schrier L, Rissmann R, ten Cate R. Comprehensive evaluation of microneedle-based intradermal adalimumab delivery vs. subcutaneous administration: results of a randomized controlled clinical trial. Br J Clin Pharmacol 2021; 87:3162-3176. [PMID: 33403697 PMCID: PMC8359405 DOI: 10.1111/bcp.14729] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS To evaluate feasibility of intradermal (i.d.) adalimumab administration using hollow microneedles, and to compare a single i.d. dose of adalimumab using a hollow microneedle with a single subcutaneous (s.c.) dose using a conventional needle. METHODS In this single-centre double-blind, placebo-controlled, double-dummy clinical trial in 24 healthy adults we compared 40 mg adalimumab (0.4 mL) administered i.d. using a hollow microneedle with a s.c. dose using a conventional needle. Primary parameters were pain, acceptability and local tolerability; secondary parameters safety, pharmacokinetics and immunogenicity. We explored usability of optical coherence tomography, clinical photography, thermal imaging, and laser speckle contrast imaging to evaluate skin reaction after i.d. injections. In vitro protein analysis was performed to assess compatibility of adalimumab with the hollow microneedle device. RESULTS While feasible and safe, injection pain of i.d. adalimumab was higher compared to s.c. adalimumab (35.4 vs. 7.9 on a 100-point visual analogue scale). Initial absorption rate and relative bioavailability were higher after i.d. adalimumab (time to maximum plasma concentration = 95 h [47-120]; Frel = 129% [6.46%]) compared to s.c. adalimumab (time to maximum plasma concentration = 120 h [96-221]). Anti-adalimumab antibodies were detected in 50% and 83% of the subjects after i.d. and s.c. adalimumab, respectively. We observed statistically significantly more erythema and skin perfusion after i.d. adalimumab, compared to s.c. adalimumab and placebo injections (P < .0001). Cytokine secretion after whole blood lipopolysaccharide challenge was comparable between administration routes. CONCLUSIONS Intradermal injection of adalimumab using hollowing microneedles was perceived as more painful and less accepted than s.c. administration, but yields a higher relative bioavailability with similar safety and pharmacodynamic effects.
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Affiliation(s)
- Justin Jacobse
- Department of Pediatric Rheumatology Willem‐Alexander Children's HospitalLeiden University Medical CenterLeidenthe Netherlands
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
- Currently also affiliated with department of PathologyMicrobiology and Immunology at Vanderbilt UniversityNashvilleTennesseeUSA
| | - Wouter ten Voorde
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | | | - Stefan G. Romeijn
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | | | - Koen van der Maaden
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | | | - Dirk Jan A.R. Moes
- Department of Clinical Pharmacy & ToxicologyLeiden University Medical CenterLeidenthe Netherlands
| | - Floris Loeff
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Karien Bloem
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Annick de Vries
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Theo Rispens
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | - Gertjan Wolbink
- Biologics Lab, Sanquin Diagnostic ServicesAmsterdamthe Netherlands
| | | | | | | | - Wim Jiskoot
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | - Joke Bouwstra
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
| | - Lenneke Schrier
- Department of Pediatric Rheumatology Willem‐Alexander Children's HospitalLeiden University Medical CenterLeidenthe Netherlands
- Currently at Princess Maxima Centre for Pediatric OncologyUtrechtthe Netherlands
| | - Robert Rissmann
- Centre for Human Drug ResearchLeidenthe Netherlands
- Division of BioTherapeutics, Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenthe Netherlands
- Department of Clinical Pharmacy & ToxicologyLeiden University Medical CenterLeidenthe Netherlands
| | - Rebecca ten Cate
- Department of Pediatric Rheumatology Willem‐Alexander Children's HospitalLeiden University Medical CenterLeidenthe Netherlands
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6
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Kruizinga MD, Moll A, Zhuparris A, Ziagkos D, Stuurman FE, Nuijsink M, Cohen AF, Driessen GJA. Postdischarge Recovery after Acute Pediatric Lung Disease Can Be Quantified with Digital Biomarkers. Respiration 2021; 100:979-988. [PMID: 34004601 DOI: 10.1159/000516328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric patients admitted for acute lung disease are treated and monitored in the hospital, after which full recovery is achieved at home. Many studies report in-hospital recovery, but little is known regarding the time to full recovery after hospital discharge. Technological innovations have led to increased interest in home-monitoring and digital biomarkers. The aim of this study was to describe at-home recovery of 3 common pediatric respiratory diseases using a questionnaire and wearable device. METHODS In this study, patients admitted due to pneumonia (n = 30), preschool wheezing (n = 30), and asthma exacerbation (AE; n = 11) were included. Patients were monitored with a smartwatch and a questionnaire during admission, with a 14-day recovery period and a 10-day "healthy" period. Median compliance was calculated, and a mixed-effects model was fitted for physical activity and heart rate (HR) to describe the recovery period, and the physical activity recovery trajectory was correlated to respiratory symptom scores. RESULTS Median compliance was 47% (interquartile range [IQR] 33-81%) during the entire study period, 68% (IQR 54-91%) during the recovery period, and 28% (IQR 0-74%) during the healthy period. Patients with pneumonia reached normal physical activity 12 days postdischarge, while subjects with wheezing and AE reached this level after 5 and 6 days, respectively. Estimated mean physical activity was closely correlated with the estimated mean symptom score. HR measured by the smartwatch showed a similar recovery trajectory for subjects with wheezing and asthma, but not for subjects with pneumonia. CONCLUSIONS The digital biomarkers, physical activity, and HR obtained via smartwatch show promise for quantifying postdischarge recovery in a noninvasive manner, which can be useful in pediatric clinical trials and clinical care.
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Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Allison Moll
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | | | | | - Frederik E Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Gertjan J A Driessen
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Maastricht University Medical Centre, Leiden, The Netherlands
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7
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Saghari M, Gal P, Ziagkos D, Burggraaf J, Powell JF, Brennan N, Rissmann R, van Doorn MBA, Moerland M. A randomized controlled trial with a delayed-type hypersensitivity model using keyhole limpet haemocyanin to evaluate adaptive immune responses in man. Br J Clin Pharmacol 2020; 87:1953-1962. [PMID: 33025648 PMCID: PMC8056735 DOI: 10.1111/bcp.14588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/13/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS Keyhole limpet haemocyanin (KLH) immunization is a clinical model for the evaluation of human antibody responses. The current study evaluated the anti-KLH antibody response after KLH immunization and the delayed-type hypersensitivity response following intradermal KLH administration, using objective imaging techniques. METHODS Healthy male subjects aged 24.5 ± 5.4 years were randomized to intramuscular immunization with 100 μg KLH (n = 12) or placebo (n = 3). Anti-KLH antibody (Ig) M and IgG titres were determined before and every 7 days after KLH immunization for a total of 28 days. Twenty-one days after the immunization, all subjects received 1 μg KLH intradermally. Prior to and 2 days after intradermal KLH administration, skin blood perfusion, erythema and oedema were quantified using noninvasive imaging tools. Repeated measures ANCOVAs were used to analyse data. RESULTS Anti-KLH IgM and IgG titres increased after KLH immunization compared to placebo (estimated difference [ED]: 37%, 95% confidence interval [CI]: 19-51% and ED: 68%, 95% CI: 56-76% respectively). Upon intradermal KLH administration an increase in skin blood perfusion (ED: 10.9 arbitrary units (AU), 95% CI: 1.4-20.4 AU) and erythema (ED: 0.3 AU, 95% CI: 0.1-0.5 AU) was observed in KLH-immunized subjects compared to placebo. CONCLUSION KLH immunization followed by intradermal KLH administration resulted in increased anti-KLH IgM and IgG titres and a delayed-type hypersensitivity response quantified by an increase in skin blood perfusion and erythema. Using noninvasive imaging tools the KLH model has the potential to serve as an objective tool to study the pharmacodynamics of T-cell-directed immunomodulatory drugs.
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Affiliation(s)
- Mahdi Saghari
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | | | | | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands.,Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | | | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
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8
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Hijma HJ, Moss LM, Gal P, Ziagkos D, de Kam ML, Moerland M, Groeneveld GJ. Challenging the challenge: A randomized controlled trial evaluating the inflammatory response and pain perception of healthy volunteers after single-dose LPS administration, as a potential model for inflammatory pain in early-phase drug development. Brain Behav Immun 2020; 88:515-528. [PMID: 32305572 DOI: 10.1016/j.bbi.2020.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/27/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND AIMS Following an infection, cytokines not only regulate the acute immune response, but also contribute to symptoms such as inflammatory hyperalgesia. We aimed to characterize the acute inflammatory response induced by a human endotoxemia model, and its effect on pain perception using evoked pain tests in two different dose levels. We also attempted to determine whether combining a human endotoxemia challenge with measurement of pain thresholds in healthy subjects could serve as a model to study drug effects on inflammatory pain. METHODS AND RESULTS This was a placebo-controlled, randomized, cross-over study in 24 healthy males. Twelve subjects were administered a bolus of 1 ng/kg LPS intravenously, and twelve 2 ng/kg LPS. Before days of placebo/LPS administration, subjects completed a full study day without study drug administration, but with identical pain threshold testing. Blood sampling and evoked pain tests (electrical burst and -stair, heat, pressure, and cold pressor test) were performed pre-dose and at frequent intervals up to 10hr post-dose. Data were analysed with a repeated-measures ANCOVA. For both dose levels, LPS induced an evident acute inflammatory response, but did not significantly affect any of the pain modalities. In a post-hoc analysis, lowering of pain thresholds was observed in the first 3 h after dosing, corresponding with the peak of the acute inflammatory response around 1-3 h post-dose. CONCLUSION Mild acute systemic inflammation, as induced by 1 ng/kg and 2 ng/kg LPS intravenous administration, did not significantly change pain thresholds in this study. The endotoxemia model in combination with evoked pain tests is not suitable to study acute inflammatory hyperalgesia in healthy males.
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Affiliation(s)
- H J Hijma
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - L M Moss
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - P Gal
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - D Ziagkos
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands.
| | - M L de Kam
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands.
| | - M Moerland
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - G J Groeneveld
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
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9
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Heuberger JAAC, Posthuma JJ, Ziagkos D, Rotmans JI, Daniels JMA, Gal P, Stuurman FE, Spronk HMH, Ten Cate H, Burggraaf J, Moerland M, Cohen AF. Additive effect of erythropoietin use on exercise-induced endothelial activation and hypercoagulability in athletes. Eur J Appl Physiol 2020; 120:1893-1904. [PMID: 32537688 PMCID: PMC7340646 DOI: 10.1007/s00421-020-04419-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
Purpose Recombinant human erythropoietin (rHuEPO) is known to increase thrombotic risk in patients and might have similar effects in athletes abusing the drug. rHuEPO is prohibited by anti-doping legislation, but this risk has not been investigated thoroughly. This analysis was designed to evaluate whether rHuEPO impacts hemostatic profile and endothelial and platelet activation markers in trained subjects, and whether the combination with exercise affects exercise induced alterations. Methods This double-blind, randomized, placebo-controlled trial enrolled healthy, trained male cyclists aged 18–50 years. Participants were randomly allocated (1:1) to receive subcutaneous injections of rHuEPO (epoetin-β; mean dose 6000 IU per week) or placebo (0.9% NaCl) for 8 weeks. Subjects performed five maximal exercise tests and a road race, coagulation and endothelial/platelet markers were measured at rest and directly after each exercise effort. Results rHuEPO increased P-selectin (+ 7.8% (1.5–14.5), p = 0.02) and E-selectin (+ 8.6% (2.0–15.7), p = 0.01) levels at rest. Maximal exercise tests significantly influenced all measured coagulation and endothelial/platelet markers, and in the rHuEPO group maximal exercise tests led to 15.3% ((7.0–24.3%), p = 0.0004) higher E-selectin and 32.1% ((4.6–66.8%), p = 0.0207) higher Platelet factor 4 (PF4) levels compared to the placebo group. Conclusion In conclusion, rHuEPO treatment resulted in elevated E- and P-selectin levels in trained cyclists, indicating enhanced endothelial activation and/or platelet reactivity. Exercise itself induces hypercoagulability, and the combination of rHuEPO and exercise increased E-selectin and PF4 levels more than either intervention alone. Based on this, exercise potentially increases thrombotic risk, a risk that might be enhanced in combination with rHuEPO use. Electronic supplementary material The online version of this article (10.1007/s00421-020-04419-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jelle J Posthuma
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Gal
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Frederik E Stuurman
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Henri M H Spronk
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Matthijs Moerland
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
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10
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van Brummelen EMJ, Ziagkos D, de Boon WMI, Hart EP, Doll RJ, Huttunen T, Kolehmainen P, Groeneveld GJ. Quantification of tremor using consumer product accelerometry is feasible in patients with essential tremor and Parkinson's disease: a comparative study. J Clin Mov Disord 2020; 7:4. [PMID: 32280482 PMCID: PMC7137336 DOI: 10.1186/s40734-020-00086-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022]
Abstract
Background To quantify pharmacological effects on tremor in patients with essential tremor (ET) or Parkinson’s Disease (PD), laboratory-grade accelerometers have previously been used. Over the last years, consumer products such as smartphones and smartwatches have been increasingly applied to measure tremor in an easy way. However, it is unknown how the technical performance of these consumer product accelerometers (CPAs) compares to laboratory-grade accelerometers (LGA). This study was performed to compare the technical performance of CPAs with LGA to measure tremor in patients with Parkinson’s Disease (PD) and essential tremor (ET). Methods In ten patients with PD and ten with ET, tremor peak frequency and corresponding amplitude were measured with 7 different CPAs (Apple iPhone 7, Apple iPod Touch 5, Apple watch 2, Huawei Nexus 6P, Huawei watch, mbientlabMetaWear (MW) watch, mbientlab MW clip) and compared to a LGA (Biometrics ACL300) in resting and extended arm position. Results Both in PD and ET patients, the peak frequency of CPAs did not significantly differ from the LGA in terms of limits of agreement. For the amplitude at peak frequency, only the iPhone and MW watch performed comparable to the LGA in ET patients, while in PD patients all methods performed comparable except for the iPod Touch and Huawei Nexus. Amplitude was higher when measured with distally-located CPAs (Clip, iPhone, iPod) compared with proximally-located CPAs (all watches). The variability between subjects was higher than within subjects for frequency (25.1% vs. 13.4%) and amplitude measurement (331% vs. 53.6%). Resting arm position resulted in lower intra-individual variability for frequency and amplitude (13.4 and 53.5%) compared to extended arm position (17.8 and 58.1%). Conclusions Peak frequencies of tremor could be measured with all tested CPAs, with similar performance as LGA. The amplitude measurements appeared to be driven by anatomical location of the device and can therefore not be compared. Our results show that the tested consumer products can be used for tremography, allowing at-home measurements, in particular in studies with a cross-over or intra-individual comparison design using the resting arm position. Trial registration This trial was registered in the Dutch Competent Authority (CCMO) database with number NL60672.058.17 on May 30th 2017.
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Affiliation(s)
| | - Dimitrios Ziagkos
- 1Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL The Netherlands
| | - Wadim M I de Boon
- 1Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL The Netherlands
| | - Ellen P Hart
- 1Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL The Netherlands
| | - Robert J Doll
- 1Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL The Netherlands
| | | | | | - Geert Jan Groeneveld
- 1Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL The Netherlands.,4Department of Anesthesiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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11
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Huizinga CR, Zuiker RG, de Kam ML, Ziagkos D, Kuipers J, Mejia Y, van Gerven JM, Cohen AF. Evaluation of simulated driving in comparison to laboratory-based tests to assess the pharmacodynamics of alprazolam and alcohol. J Psychopharmacol 2019; 33:791-800. [PMID: 30912701 DOI: 10.1177/0269881119836198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/22/2022]
Abstract
RATIONALE Assessment of the effects of medicines on the risks of car driving must be derived from laboratory tests, simulated driving or real on-road driving tests. Relevance of tests is determined by their sensitivity and predictive ability for the probability of accidents or damage. This cannot be determined directly, but methods should be able to at least detect the effects of a positive control in dosage known to be clearly associated with increased risk. OBJECTIVES A driving simulator was evaluated in comparison with a battery of validated tests of CNS performance, the NeuroCart®. Alcohol in a concentration exactly at the legal limit (0.5 g L-1) and well above (1.0 g L-1) as well as alprazolam (1 mg) was used as positive control. METHODS This was a randomised, cross-over study using a double dummy blinded design in 24 healthy study subjects (12 M, 12 F) aged 20-43 years. Alcohol was infused intravenously using a validated clamping protocol to obtain concentrations of 0.5 g L-1 and on another occasion 1.0 g L-1. Alprazolam was given orally. Driving tests and lab tests were done at regular time intervals during a study day. RESULTS Alprazolam and alcohol significantly affected the main parameters of driving in the simulator and affected scores of safe driving and alprazolam increased the odds ratio of a virtual crash. Several laboratory measurements of psychomotor performance were affected by the reference substances as expected and correlated significantly with the driving performance. CONCLUSIONS The driving simulator can detect effects of reference substances at levels that are known to negatively affect driving.
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Affiliation(s)
| | - Rob G Zuiker
- 1 Centre for Human Drug Research, Leiden, The Netherlands
| | | | | | | | - Yuri Mejia
- 1 Centre for Human Drug Research, Leiden, The Netherlands
| | | | - Adam F Cohen
- 1 Centre for Human Drug Research, Leiden, The Netherlands
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12
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Kovalchuk MO, Heuberger JAAC, Sleutjes BTHM, Ziagkos D, van den Berg LH, Ferguson TA, Franssen H, Groeneveld GJ. Acute Effects of Riluzole and Retigabine on Axonal Excitability in Patients With Amyotrophic Lateral Sclerosis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. Clin Pharmacol Ther 2018; 104:1136-1145. [PMID: 29672831 DOI: 10.1002/cpt.1096] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/07/2022]
Abstract
Increased excitability of motor neurons in patients with amyotrophic lateral sclerosis (ALS) may be a relevant factor leading to motor neuron damage. This randomized, double-blind, three-way crossover, placebo-controlled study evaluated peripheral motor nerve excitability testing as a biomarker of hyperexcitability and assessed the effects of riluzole and retigabine in 18 patients with ALS. We performed excitability testing at baseline, and twice after participants had received a single dose of either 100 mg riluzole, 300 mg retigabine, or placebo. Between- and within-day repeatability was at least acceptable for 14 out of 18 recorded excitability variables. No effects of riluzole on excitability testing were observed, but retigabine significantly decreased strength-duration time-constant (9.2%) and refractoriness at 2 ms (10.2) compared to placebo. Excitability testing was shown to be a reliable biomarker in patients with ALS, and the acute reversal of previously abnormal variables by retigabine justifies long-term studies evaluating the impact on disease progression and survival.
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Affiliation(s)
- Maria O Kovalchuk
- University Medical Center Utrecht, Department of Neurology, Utrecht, the Netherlands
| | | | | | | | | | - Toby A Ferguson
- Biogen, Department of Neurology Research and Early Clinical Development, Cambridge, Massachusetts, USA
| | - Hessel Franssen
- University Medical Center Utrecht, Department of Neurology, Utrecht, the Netherlands
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13
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Rovito R, Korndewal MJ, van Zelm MC, Ziagkos D, Wessels E, van der Burg M, Kroes ACM, Langerak AW, Vossen ACTM. T and B Cell Markers in Dried Blood Spots of Neonates with Congenital Cytomegalovirus Infection: B Cell Numbers at Birth Are Associated with Long-Term Outcomes. J Immunol 2016; 198:102-109. [PMID: 27903736 DOI: 10.4049/jimmunol.1601182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022]
Abstract
Congenital CMV infection (cCMV) is the most common congenital infection that can cause long-term impairment (LTI). The pathogenesis of LTI is not completely understood. Fetal immunity may play a role in controlling the infection and preventing LTI, although immune activation may also contribute to fetal immunopathology. In this study, we analyzed various molecular markers of T and B cell numbers in neonatal dried blood spots of 99 children with cCMV and 54 children without cCMV: δRec-ψJα signal joints on TCR excision circles, intron recombination signal sequence k-deleting element signal joints on Igκ-deleting recombination excision circles, genomic intron recombination signal sequence k-deleting element coding joint, genomic Vδ1-Jδ1, and Vδ2-Jδ1 rearrangements. Of this cohort, clinical symptoms at birth and LTI at 6 y of age were recorded. Neonates with cCMV had fewer TCR excision circles in their blood than non-infected controls. Furthermore, cCMV infection was associated with increased numbers of γδ T cells and B cells, and these numbers were positively correlated with CMV viral load in the dried blood spots. Infected children with a better long-term outcome had higher numbers of B cells at birth than those who developed LTI; no difference in B cell replication was observed. The potential protective role of B cells in controlling cCMV-related disease and the clinical value of this marker as a predictor of long-term outcome merit further evaluation.
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Affiliation(s)
- Roberta Rovito
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands;
| | - Marjolein J Korndewal
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.,Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute of Public Health and the Environment, 3720 BA, Bilthoven, the Netherlands
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia
| | - Dimitrios Ziagkos
- Medical Statistics and Bioinformatics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands; and
| | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Mirjam van der Burg
- Department of Immunology, Erasmus MC University Medical Centre Rotterdam, 3015 CN, Rotterdam, the Netherlands
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Anton W Langerak
- Department of Immunology, Erasmus MC University Medical Centre Rotterdam, 3015 CN, Rotterdam, the Netherlands
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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