Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors

BACKGROUND

Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented.

METHODS

Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome.

RESULTS

There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors.

CONCLUSIONS

In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT02329327.

Occupational physicians dealing with mental health: between employee and company interests: a qualitative study

BACKGROUND

Occupational health physicians are increasingly confronted with mental health issues at their workplace. Facing them, most of them feel insecure and not sufficiently trained. Employee's mental well-being depends at the same time on individual and significantly on organizational variables. This complicates the physician's position, since they have to serve many interests. The focus of the present study is to investigate what difficulties occupational health physicians face and how organizational culture and management influence their work.

METHODS

Interviews were conducted with N = 25 physicians as part of a training for basic mental health care. Interviews were interpreted using qualitative content analysis.

RESULTS

Working with mentally ill employees was difficult for the physicians interviewed. Many felt insecure managing and preventing mental health issues. A need for further education was observed. Environmental factors (organizational culture, management) have a strong impact on the work of an occupational health physician and highlight its systemic dimension. Even though many of our participants report a meanwhile more open attitude towards mental disorders at their workplace, on the level of direct contact to the management prevail descriptions of little acceptance and a high priority of economic outcomes.

CONCLUSIONS

More education on topics of mental health is needed for occupational health physicians. Future trainings should consider the intertwined nature of their work and enable them in dealing consciously with other actors in the company. For enhancing employee's mental well-being occupational health physicians could be granted a strengthened position in companies or be supported through more exchange with colleagues in other companies.

Sleep Position Detection for Closed-Loop Treatment of Sleep-Related Breathing Disorders

Reliable detection of sleep positions is essential for the development of technical aids for patients with position-dependent sleep-related breathing disorders. We compare personalized and generalizable sleeping position classifiers using unobtrusive eight-channel pressure-sensing mats. Data of six male patients with confirmed position-dependent sleep apnea was recorded during three subsequent nights. Personalized position classifiers trained using leave-one-night-out cross-validation on average reached an F1-score of 61.3% for supine/non-supine and an F1-score of 46.2% for supine/lateral-left/lateral-right classification. The generalizable classifiers reached average F1-scores of 62.1% and 49.1% for supine/non-supine and supine/lateral-left/lateral-right classification, respectively. In-bed presence ("bed occupancy") could be detected with an average F1-score of 98.1%. This work shows that personalized sleep-position classifiers trained with data from two nights have comparable performance to classifiers trained with large interpatient datasets. Simple eight-channel sensor mattresses can be used to accurately detect in-bed presence required for closed-loop systems but their use to classify sleep-positions is limited.

A Single-Day Training for Managers Reduces Cognitive Stigma Regarding Mental Health Problems: A Randomized Trial

Background: Mental illnesses have received increasing attention in the work context in recent years, yet they are still often accompanied by stigma. One starting point for stigma reduction is interventions in the workplace. The present study evaluated a one-day workshop for managers in a large company. Method: Enrolled managers (n = 70) were randomly assigned to the intervention group and the waiting control group. The training included a theoretical section on mental and stress-related diseases as well as the interplay between work and health, group work on personal stress experience, theoretical input on dealing with mentally ill employees, and a group discussion on this topic along with case studies. Both groups completed the following questionnaires at baseline and three months after training: Effort–Reward Imbalance Questionnaire, Patient Health Questionnaire, Mental Health Knowledge Schedule, Social Distance Scale, and the Irritation Scale. Results: Compared to the waiting group, the intervention group showed a significant improvement in the Mental Health Knowledge Schedule (U = 417.00, p = 0.040) and an increase in the Irritation Scale (U = 371.50 p = 0.011). All other scales remained unchanged. Conclusion: The content and duration of the training were adequate to reduce cognitive stigma towards mental illness. However, the present approach was not sufficient for an improvement in the subjective stress level of the participating managers.

Effects of Extraction Conditions on Banana Peel Polyphenol Oxidase Activity and Insights into Inactivation Kinetics Using Thermal and Cold Plasma Treatment

The objective of this work was to characterize banana peel polyphenol oxidase (PPO) and to study the inactivation kinetics during thermal and cold atmospheric pressure plasma treatment. Since varietal differences in enzyme characteristics are a well-known phenomenon, 'Prata' banana peel PPO was characterized, and PPO activity and thermal stability of the peel PPO of the two dessert banana cultivars 'Cavendish' and 'Prata' were compared to identify the cultivar better suited for industrial food applications. A crude extract obtained from the peels of the Brazilian banana variety 'Prata' revealed highest PPO activities (46.0-55.2 nkat/mL) at 30-40 °C in a range of pH 6.0-6.5 after addition of 0.5 g/g_sample polyvinylpyrrolidone and 0.5% (v/v) Triton X-100 during extraction. 'Cavendish' PPO activity was four times higher. Banana peel PPO exhibited the highest affinity towards dopamine (K_M = 0.94 mM). Thermal inactivation of 'Prata' and 'Cavendish' PPO was achieved at 90 °C after 5 and 15 min, respectively, whereas cold plasma treatment did not decrease PPO activity below 46% of the initial enzyme activity. The inactivation behavior of PPO could successfully be described by a two-fraction model indicating at least two types of isoenzymes with different thermal stability. The overall high thermal stability was mainly attributed to membrane-bound PPO. The results may help to prevent enzymatic browning of banana peels and thereby facilitate their valorization as food ingredients.

Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises - study protocol for a randomized controlled-trial

BACKGROUND

Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine und mittlere Unternehmen - Gesundheitsoffensive; en: small and medium-sized enterprises - health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees.

METHODS

The study is planned as a 2 × 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees' mental health. Further dependent variables are leaders´ depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers' point of view.

DISCUSSION

Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders´ and also employees` mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives.

TRIAL REGISTRATION

The KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (05.11.2020).

AB0933 PHYSICAL ACTIVITY DECREASES PAIN AND INFLAMMATION IN GOUT PATIENTS

Background:

Despite the high prevalence of gout, there has been little investigation into the relationship between physical activity and gout.

Objectives:

To investigate whether physically active gout patients, as assessed by the International Physical Activity Questionnaire (IPAQ) long form, have lower pain scores, decreased inflammation, assessed by C-reactive protein (CRP) levels and less flares.

Methods:

During scheduled appointments, gout patients not experiencing a flare at the time of visit were recruited from our clinics and consented to participate in the study. IPAQ were completed. Clinical data collected during the visit included age, years since diagnosis, flares per year, perceived pain at the time of visit and in the past 4 weeks, and C-reactive protein (CRP) levels.

Results:

Thirty gout patients were recruited. Ages 31-86 (mean 61); duration of gout: one- 43 years (mean 9). IPAQ, separated gout patients into physically active (n=16) and physically inactive cohorts (n=14) (p<0.001. Physically active gout patients had over 12-fold fewer gout flares per year (p<0.01); 10-fold less CRP (p<0.01, a 4.6-fold decrease in perceived pain at the time of visit (p<0.01), and a 2.8-fold decrease in perceived pain over the past 4-week period (p<0.05).

Conclusion:

This is the first study using a validated physical activity tool, IPAQ, to assess physical activity in gout patients. In this study, physically active gout patients were found to have lower CRP levels, less flares per year, and decreased pain perception compared to those that are not physically active, highlighting, the importance of incorporating physical activity as a possible adjunct treatment option during intervals between flares.

References:

[1]Benatti FB, Pedersen BK. Exercise as an anti-inflammatory therapy for rheumatic diseases-myokine regulation. Nat Rev Rheumatol 2015;11:86-97.

[2]Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr 2006;9:755-62.

[3]Young NA, Jablonski K, Sharma J, Thomas E, Snoad B, Hampton J, et al. Low and Moderate Intensity Exercise Suppresses Inflammatory Responses in an Acute Mouse Model of Gout and Suggests Therapeutic Efficacy [abstract]. Arthritis Rheumatol. 2017;69 (suppl 10).

Disclosure of Interests:

Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon, Kyle jablonski: None declared, Emmy schwarz: None declared, Nicholas Young: None declared

Long-Term Attitude Change After a Single-Day Manager Training Addressing Mental Health at the Workplace

Mental health problems have become one of the most common causes of incapacity for work, and engender high costs to society. Especially managerial behavior was found to have a great impact on employees' well-being. In order to support those in leading positions in dealing with their own, as well as their employees', psychological stress factors, we conducted a specific manager training. At the same time, we wanted to find out about the training's short- and long-term effects. Participants were asked to give information about their knowledge and attitudes concerning mental health (Mental Health Knowledge Schedule, Social Distance Scale), as well as to comment on their own health condition (12-Item Short Form Health Survey, Patient Health Questionnaire) and working situation (Effort-Reward Inventory, Irritation Scale). Data were collected at baseline, as well as 3 and 12 months after the training. Results show long-term improvements in knowledge and attitudes measured by the Mental Health Knowledge Schedule (MAKS: Mt1 = 22.88, Mt2 = 23.79, Mt3 = 23.79, p = 0.005) but not in the Social Distance Scale (SoDi: Mt1 = 0.96, Mt2 = 0.85, Mt3 = 0.84, p = 0.165). Over the period of time observed, no changes were found regarding health- or work-related instruments. Due to the uncontrolled design of the study, further research is needed to determine the exact effectiveness.

Psychische Erkrankungen im Arbeitskontext – eine Verortung im Versorgungssystem

Work and mental health are closely interrelated. Sick leave rates due to mental illness have constantly been rising for years. Thus, not only companies but also the society as a whole have become more and more aware of the relevance of this topic.At first, various work stress models are outlined in this article. This is followed by an overview of how to classify work-related mental disorders in the ICD and DSM systems. Burnout is explained with regard to terminology, origin and adequate use in clinical practice. Furthermore, the ILO (International Labour Organization) classification of work-related mental disorders is presented. Possible intervention models for the prevention and therapy of work-related mental health problems are discussed. In addition, the most essential components of work-related psychotherapy are pointed out. Finally, corresponding guidelines are put into an international context.

Load transfer and periprosthetic fractures after total hip arthoplasty: Comparison of periprosthetic fractures of femora implanted with cementless distal-load or proximal-load femoral components and measurement of the femoral strain at the time of implantation

BACKGROUND

Little is known about the causes and mechanisms underlying periprosthetic fractures around femoral components particularly in relation to the stem design. In an in vitro study 20 pairs of fresh cadaveric femora were loaded to fracture axially and transversally.

FINDINGS

When proximal femoral strain was measured at the time of impaction of cementless stems the load transfer was determined by the underlying anatomy rather than by the shape of the stem, so that the so-called "load transfer" properties - proximal or distal - ascribed to stem designs are a myth. The axial-load and the transverse-load model were then exposed to loads to failure (fracture) and showed a biphasic pattern throughout independent of the impact direction. In the second phase, the fracture phase proper, the bone behaved like a brittle solid. Failure occurred very rapidly within less than 5 milliseconds. The forces to failure were between 2 and 11 kN. Most of the fractures (82.5%) occurred above the stem tip.

INTERPRETATION

Note that the study was confined to early preosteointegration fractures. Neither the stem design nor the impact direction, i.e. on the knee or on the side of the hip, was related to the fracture morphology.

Depression in Parkinsonism Treated by Prefrontal Leucotomy

This is a description of a case of depression associated with post-encephalitic Parkinsonism, with signs predominating on the left side, treated by unilateral (right) prefrontal leucotomy.

[The Aut-idem Rule and the Importance of Patient-Individual Selection of Inhalers for the Therapy of Airway Diseases in Practices of Pneumologists and General Practitioners - Assessment and Implementation by Pneumologists and General Practitioners]

Drug therapy of obstructive airway diseases mainly relies on inhaled medication. The success of this therapy depends primarily on the selection of the appropriate inhaler considering patient's choice and the correct application. The aut-idem-rule, an active exclusion of the optional substitution by the pharmacist, allows prescribing physicians to ensure the delivery of a particular inhaler, which was selected for that patient, who was trained to use specifically that inhaler. This survey shows that pneumologists and, to a greater extent general practitioners, do not consistently make use of this option, although they unanimously agree on the importance of targeted inhaler selection. As a result, patients may receive different inhalers in the pharmacy, where the inhaler is chosen under consideration of market-driven aspects such as rebate contracts or stock. This causes that patients get confused by the exchange of their inhaler. Thus the exchange of the inhaler by the pharmacist leads to uncertainty and application problems in patients. Hence, the success of the comparatively complex inhaled therapy is endangered. This could be prevented, if prescribing physicians were informed and supported consistently regarding the use of aut-idem exclusion to ensure an optimal therapy for each individual patient.

Differential melatonin alterations in cerebrospinal fluid and serum of patients with major depressive disorder and bipolar disorder

BACKGROUND

Melatonin, which plays an important role for regulation of circadian rhythms and the sleep/wake cycle has been linked to the pathophysiology of major depressive and bipolar disorder. Here we investigated melatonin levels in cerebrospinal fluid (CSF) and serum of depression and bipolar patients to elucidate potential differences and commonalities in melatonin alterations across the two disorders.

METHODS

Using enzyme-linked immunosorbent assays, CSF and serum melatonin levels were measured in 108 subjects (27 healthy volunteers, 44 depressed and 37 bipolar patients). Covariate adjusted multiple regression analysis was used to investigate group differences in melatonin levels.

RESULTS

In CSF, melatonin levels were significantly decreased in bipolar (P<0.001), but not major depressive disorder. In serum, we observed a significant melatonin decrease in major depressive (P=0.003), but not bipolar disorder. No associations were found between serum and CSF melatonin levels or between melatonin and measures of symptom severity or sleep disruptions in either condition.

CONCLUSION

This study suggests the presence of differential, body fluid specific alterations of melatonin levels in bipolar and major depressive disorder. Further, longitudinal studies are required to explore the disease phase dependency of melatonin alterations and to mechanistically explore the causes and consequences of site-specific alterations.

Evidence for disturbed insulin and growth hormone signaling as potential risk factors in the development of schizophrenia

Molecular abnormalities in metabolic, hormonal and immune pathways are present in peripheral body fluids of a significant subgroup of schizophrenia patients. The authors have tested whether such disturbances also occur in psychiatrically ill and unaffected siblings of schizophrenia patients with the aim of identifying potential contributing factors to disease vulnerability. The subjects were recruited as part of the Genetic Risk and OUtcome of Psychosis (GROUP) study. The authors used multiplexed immunoassays to measure the levels of 184 molecules in serum from 112 schizophrenia patients, 133 siblings and 87 unrelated controls. Consistent with the findings of previous studies, serum from schizophrenia patients contained higher levels of insulin, C-peptide and proinsulin, decreased levels of growth hormone and altered concentrations of molecules involved in inflammation. In addition, significant differences were found in the levels of some of these proteins in siblings diagnosed with mood disorders (n=16) and in unaffected siblings (n=117). Most significantly, the insulin/growth hormone ratio was higher across all groups compared with the controls. Taken together, these findings suggest the presence of a molecular endophenotype involving disruption of insulin and growth factor signaling pathways as an increased risk factor for schizophrenia.

[Biomarker research in neuropsychiatry: challenges and potential]

The introduction of blood-based biomarkers for psychiatric disorders faces numerous challenges. The goal of research efforts is the improvement of the current more or less subjective diagnosis, treatment and patient management. So far attempts to introduce molecular analyses have faced considerable resistance. There is an urgent need for a paradigm shift so that peripheral markers may also deliver insights into pathological states of the brain. Health regulators have called for a reform of research and development approaches, with the goal to enhance the safety and efficiency of future antipsychotic drugs using biomarker-based methods. Here we discuss the potential of the biomarker sector in this context, as exemplified by the recent introduction of Veripsych™, the first blood test aiding the diagnosis of schizophrenia.

Identification of a biological signature for schizophrenia in serum

Biomarkers are now used in many areas of medicine but are still lacking for psychiatric conditions such as schizophrenia (SCZ). We have used a multiplex molecular profiling approach to measure serum concentrations of 181 proteins and small molecules in 250 first and recent onset SCZ, 35 major depressive disorder (MDD), 32 euthymic bipolar disorder (BPD), 45 Asperger syndrome and 280 control subjects. Preliminary analysis resulted in identification of a signature comprised of 34 analytes in a cohort of closely matched SCZ (n=71) and control (n=59) subjects. Partial least squares discriminant analysis using this signature gave a separation of 60-75% of SCZ subjects from controls across five independent cohorts. The same analysis also gave a separation of ~50% of MDD patients and 10-20% of BPD and Asperger syndrome subjects from controls. These results demonstrate for the first time that a biological signature for SCZ can be identified in blood serum. This study lays the groundwork for development of a diagnostic test that can be used as an aid for distinguishing SCZ subjects from healthy controls and from those affected by related psychiatric illnesses with overlapping symptoms.

The Monitor Practice Programme: is non-invasive management of dental caries in private practice cost-effective?

BACKGROUND

The objective of this research was to assess the efficacy and cost-effectiveness of a non-invasive approach to dental caries management in private dental practice.

METHODS

Private dental practices from a variety of locations in New South Wales were randomly allocated to either non-invasive management of caries, or continue with usual care. Patients were followed for three years and caries incidence assessed. A patient-level decision analytic model was constructed to assess the cost-effectiveness of the intervention at two years, three years, and hypothetical lifetime.

RESULTS

Twenty-two dental practices and 920 patients were recruited. Within the clinical trial there was a significant difference in caries increment favouring non-invasive therapy at both two and three years. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations both urban and rural. Cost per DMFT avoided estimate was A$1287.07 (two years), A$1148.91 (three years) decreasing to A$702.52 in (medium) and A$545.93 (high) risk patients (three years).

CONCLUSIONS

A joint preventive and non-invasive therapeutic approach appears to be cost-effective in patients at medium and high risk of developing dental caries when compared to the standard care provided by private dental practice.

A gene coding for tRNA is located near 5' terminus of 16S rRNA gene in Zea mays chloroplast genome

A region of 635 base pairs preceding a gene for 16S rRNA in the Zea mays chloroplast genome has been mapped and its sequence has been determined. Screening for structural elements common to tRNAs reveals a gene coding for tRNA(Val) (GU(U) (C)) positioned 303 base pairs proximal to the 5' end of the 16S rRNA gene. Both the tRNA(Val) and the 16S rRNA are coded in the same DNA strand. The tRNA nucleotide sequence predicted from the DNA sequence meets all structural characteristics common to tRNA primary and secondary structures. In a quantitative comparison with primary structures of the 14 known tRNA(Val) species the chloroplast isoaceptor shows much higher homology with that from prokaryotic than that from eukaryotic species. Regions that Escherichia coli RNA polymerase protects from nuclease attack are observed 25 and 100 base pairs upstream of the tRNA(Val) gene and 105 base pairs upstream of the 16S rRNA gene. Within these regions are short sequences that are very similar to those in the -35 region of E. coli rrn and that may therefore represent all or parts of transcription initiation signals of the respective genes.

Differential effects on T-cell function following exposure to serum from schizophrenia smokers

Cigarette smoking is more prevalent in subjects with schizophrenia compared to those with other psychiatric disorders or the general population and could therefore affect molecular pathways that impact the pathophysiology of this disorder. As smoking is also known to suppress immune responses, we investigated the effects of 'smoking-conditioned' serum obtained from schizophrenia and control subjects on healthy T cell in vitro. We found that T-cell proliferation was significantly increased following exposure to serum from smoking schizophrenia patients whereas no effect was observed when using serum from smoking control subjects or non-smoking patients and controls. We eliminated the possibility that these effects were due to quantitative differences in cigarette consumption as serum levels of the stable nicotine metabolite cotinine were similar in schizophrenic and control smokers. Molecular characterization showed that serum from patient smokers increased expression of T-cell activation markers CD69(high), CD25(high), co-stimulatory molecules CD26+, CD27+ and CD28+, and decreased T-cell receptor complex components TCRalpha/beta and CD3. Moreover, analysis of supernatants collected after T-cell exposure to serum from smoking patients showed a time-dependent decline in interleukin (IL)-2 levels, suggesting that the proliferation effect is promoted by enhanced IL-2 processing. These results suggest that cigarette smoking has selective effects on serum components that, in turn, lead to altered immune function in schizophrenia patients relative to healthy subjects. Further studies aimed at characterizing these components could result in a better understanding of the onset and aetiology of schizophrenia and potentially lead to novel therapeutic strategies.

Expression profiling of fibroblasts identifies cell cycle abnormalities in schizophrenia

Many previous studies have attempted to gain insight into the underlying pathophysiology of schizophrenia by studying postmortem brain tissues of schizophrenia patients. However, such analyses can be confounded by artifactual features of this approach such as lengthy agonal state and postmortem interval times. As several aspects of schizophrenia are also manifested at the peripheral level in proliferating cell types, we have studied the disorder through systematic transcriptomic and proteomic analyses of skin fibroblasts biopsied from living patients. We performed comparative transcriptomic and proteomic profiling to characterize skin fibroblasts from schizophrenia patients compared to healthy controls. Transcriptomic profiling using cDNA array technology showed that pathways associated with cell cycle regulation and RNA processing were altered in the schizophrenia subjects (n = 12) relative to controls (n = 12). LC-MS(E) proteomic profiling led to identification of 16 proteins that showed significant differences in expression between schizophrenia (n = 11) and control (n = 11) subjects. Analysis in silico revealed that these proteins were also associated with proliferation and cell growth pathways. To validate these findings at the protein level, fibroblast protein extracts were analyzed by Western blotting which confirmed the differential expression of three key proteins associated with these pathways. At the functional level, we confirmed the decreased proliferation phenotype by showing that cultured fibroblasts from schizophrenia subjects (n = 5) incorporated less (3)H-thymidine into their nuclei compared to those from controls (n = 6) by day 4 over an 8 day time course study. Similar abnormalities in cell cycle and growth pathways have been reported to occur in the central nervous system in schizophrenia. These studies demonstrate that fibroblasts obtained from living schizophrenia subjects show alterations in cellular proliferation and growth pathways. Future studies aimed at characterizing such pathways in fibroblasts and other proliferating cell types from schizophrenia patients could elucidate the molecular mechanisms associated with the pathophysiology of schizophrenia and provide a useful model to support drug discovery efforts.

A novel TWO-STEP renaturation procedure for efficient production of recombinant BMP-2

Bone morphogenetic proteins (BMPs) stimulate bone formation and thus constitute important protein therapeutics. Here, a novel procedure is presented which allows fast and efficient production of biologically active BMP-2 via a TWO-STEP procedure: the conditions are designed such that the first step favors formation of monomeric species with the correct intramolecular disulfide bridges, the conditions of the second folding reaction stimulate the formation of the intermolecular disulfide bridge. The short processing times and increased yields compared to previously published procedures allow low-cost production of this important protein drug.