Inebilizumab reduces neuromyelitis optica spectrum disorder risk independent of FCGR3A polymorphism

Inebilizumab, a humanized, glycoengineered, IgG1 monoclonal antibody that depletes CD19+ B-cells, is approved to treat aquaporin 4 (AQP4) IgG-seropositive neuromyelitis optica spectrum disorder (NMOSD). Inebilizumab is afucosylated and engineered for enhanced affinity to Fc receptor III-A (FCGR3A) receptors on natural killer cells to maximize antibody-dependent cellular cytotoxicity. Previously, the F allele polymorphism at amino acid 158 of the FCGR3A gene (F158) was shown to decrease IgG-binding affinity and reduce rituximab (anti-CD20) efficacy for NMOSD attack prevention. In contrast, our current findings from inebilizumab-treated NMOSD patients indicate similar clinical outcomes between those with F158 and V158 allele genotypes.

Time for a standardized diagnostic response test in patients with chronic inflammatory demyelinating polyradiculoneuropathy?

Standardized pharmacological response tests are important and established diagnostic tools in the field of neurology. However, regarding therapeutic responses to intravenous immunoglobulins (IVIg) in CIDP, neither a definition of therapeutic response has been established, nor a response test has been suggested so far. Here we suggest a practical clinical approach which is supported by current literature in the field. An established standardized IVIg response test could avoid prolonged therapy without benefit for the patient and ensure a timely therapy switch or treatment escalation if required. This approach would also be advantageous due to the global scarcity of plasma derivatives as a human resource and could be the foundation to be adjusted and improved by subsequent studies.

SARS-CoV-2 vaccination and infection in ozanimod-treated participants with relapsing multiple sclerosis

OBJECTIVE

To investigate the serologic response, predictors of response, and clinical outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and infection in ozanimod-treated participants with relapsing multiple sclerosis (RMS) from DAYBREAK.

METHODS

DAYBREAK (ClinicalTrials.gov-NCT02576717), an open-label extension study of oral ozanimod 0.92 mg, enrolled participants aged 18-55 years with RMS who completed phase 1-3 ozanimod trials. Participants who were fully vaccinated against SARS-CoV-2 with mRNA or non-mRNA vaccines, were unvaccinated, and/or had COVID-19-related adverse events (AEs, with or without vaccination) and postvaccination serum samples were included (n = 288). Spike receptor binding domain (RBD) antibody levels (seroconversion: ≥0.8 U/mL) and serologic evidence of SARS-CoV-2 infection (nucleocapsid IgG: ≥1 U/mL) were assessed (Roche Elecsys/Cobas e411 platform).

RESULTS

In fully vaccinated participants (n = 148), spike RBD antibody seroconversion occurred in 90% (n = 98/109) of those without serologic evidence of prior SARS-CoV-2 exposure (100% [n = 80/80] seroconversion after mRNA vaccination) and in 100% (n = 39/39) of participants with serologic evidence of viral exposure. mRNA vaccination predicted higher spike RBD antibody levels, whereas absolute lymphocyte count (ALC), age, body mass index, and sex did not. COVID-19-related AEs were reported in 10% (n = 15/148) of fully vaccinated participants-all were nonserious and not severe; all participants recovered.

INTERPRETATION

Most ozanimod-treated participants with RMS mounted a serologic response to SARS-CoV-2 vaccination and infection, regardless of participant characteristics or ALC levels. In this analysis, all COVID-19-related AEs post-full vaccination in participants taking ozanimod were nonserious and not severe.

Factors associated with headache in intravenous immunoglobulin treatment for neurological diseases

OBJECTIVES

To identify possible risk factors influencing the incidence of intravenous immunoglobulin (IVIg) treatment-related cephalalgia in neurological diseases.

MATERIALS & METHODS

Retrospective chart review of neurological patients receiving IVIg treatment between July 13, 2017, and August 14, 2017. Patients with MS receiving natalizumab in the same setting were observed as a reference group.

RESULTS

Patients with headache after IVIg infusion (n = 22 infusions) showed a reduced heart rate (by 6.0 ± 8.5 beats per minute [bpm]), but no significant difference in blood pressure. Patients without headache after IVIg infusion (n = 69 infusions) showed a higher systolic blood pressure increase and a stronger reduction in the heart rate (by 5.7 ± 8.6 bpm), compared to patients with headache after IVIg infusion. The infusion rate was significantly slower and age significantly lower in patients developing headache after IVIg infusion. Body temperature was unchanged in both groups. Binary logistic regression analysis revealed that blood pressure at baseline and age significantly influence the occurrence of cephalalgia. In reference, patients receiving natalizumab (ie, shorter infusions/smaller infusion volume), systolic blood pressure, and heart rate decreased, while body temperature increased. Here, one patient developed headache.

CONCLUSIONS

Intravenous immunoglobulin-associated headache is not associated with an increased blood pressure after infusion but with a reduced heart rate, a slower infusion rate, female sex and seems to be influenced by baseline systolic blood pressure and age. A reaction to immunoglobulin aggregates, stabilizers, or vasoactive mediators are possible explanations. The absence of an association with body temperature does not suggest a systemic immune response as a cause for headache.

High-frequency stimulation of the subthalamic nucleus inhibits the firing of juxtacellular labelled 5-HT-containing neurones

High-frequency stimulation (HFS) of the subthalamic nucleus (STN) is an established neurosurgical therapy for movement disability in advanced Parkinson's disease (PD), but some patients experience psychiatric side-effects like depression. In a previous electrophysiological study, we observed that HFS of the STN inhibited a population of neurones in the rat dorsal raphe nucleus (DRN), with firing properties characteristic of 5-HT neurones. The present study extended these findings to a second population of neurones, and combined extracellular recording with juxtacellular-labelling to investigate the chemical identity of the neurones affected by HFS. Bilateral HFS (130 Hz, 100-200 μA, 5 min) of the STN inhibited (26.0±2.9%) the firing of 37/74 DRN neurones displaying a slow, regular firing pattern. Slower firing neurones were more strongly inhibited than those firing faster. Importantly, 10 inhibited DRN neurones were juxtacellular-labelled with neurobiotin, and all neurones contained 5-HT as shown by post-mortem 5-HT immunocytochemistry. A minority of slow firing DRN neurones (18/74) were activated by STN HFS (37.9±8.3%) which was not observed previously. Of these neurones, three were juxtacellular-labelled and one was 5-HT immunopositive. Also a small number of DRN neurones (19/74) did not respond to HFS, four of which were juxtacellular-labelled and all contained 5-HT. These data show that individual chemically-identified 5-HT-containing neurones in the DRN were modulated by STN HFS, and that the majority were inhibited but some were activated and some failed to respond. These data extend previous findings of modulation of the 5-HT system by STN HFS but suggest a destabilisation of the 5-HT system rather than simple inhibition as indicated previously. Although the mechanism is not yet known, such changes may contribute to the psychiatric side-effects of STN stimulation in some PD patients.

Effects of essential oils from fennel (Foeniculi aetheroleum) and caraway (Carvi aetheroleum) in pigs

The ban of antibiotics as a feed additive requires alternatives to stabilize the health and performance particularly of the young animals. Essential oils obtained from fennel seed (Foeniculi aetheroleum) and caraway seed (Carvi aetheroleum) were tested in diets for weaned piglets in comparison with either a diet without feed additive or with a combination of formic acid and copper (positive control). Four groups of sixteen piglets (live weight 7 kg, age 26 days) received diets without (1) or with supplements of 7.5 g formic acid + 160 mg Cu/kg (2), 100 mg fennel oil/kg (3) or 100 mg caraway oil/kg (4) during 3 weeks after weaning. In the subsequent 4 weeks, all piglets were fed a diet without these additions. Fennel oil contained almost 2/3 anethol, approximately 1/5 fenchon and the remaining part consisting of alpha + beta-pinen, limonen (p-mentha-1,8-dien) and estragol. In the caraway oil, half of the contents was represented by limonen and the other half by carvon. There were no piglet losses and only few cases of diarrhoea. The combination of formic acid and copper increased feed consumption by 27% and daily weight gain by 25%. There were no differences in the performance between the group fed fennel oil and the control without additives. Piglets fed caraway oil tended to consume less feed and to gain approximately 10% less. In feed choice experiments, pigs consumed the same two diets from two troughs with 50% of total feed amount, as expected. The diets containing fennel or caraway oils were consumed at less than 50%. If the diet contained 100 mg fennel oil/kg, the decrease of percentual feed intake was significant. The results of the feeding experiment and of the feed choice experiment question the classification of fennel and caraway oils as flavour additives or as 'appetite promoters' in diets for weaned piglets.

Mechanisms of immune regulation in the peripheral nervous system

The peripheral nervous system (PNS) is a target for heterogenous immune attacks mediated by different components of the systemic immune compartment. T cells, B cells, and macrophages can interact with endogenous, partially immune-competent glial cells and contribute to local inflammation. Cellular and humoral immune functions of Schwann cells have been well characterized in vitro. In addition, the interaction of the humoral and cellular immune system with the cellular and extracellular components in the PNS may determine the extent of tissue inflammation and repair processes such as remyelination and neuronal outgrowth. The animal model experimental autoimmune neuritis (EAN) allows direct monitoring of these immune responses in vivo. In EAN contributions to regulate autoimmunity in the PNS are made by adhesion molecules and by cytokines that orchestrate cellular interactions. The PNS has a significant potential to eliminate T cell inflammation via apoptosis, which is almost lacking in other tissues such as muscle and skin. In vitro experiments suggest different scenarios how specific cellular and humoral elements in the PNS may sensitize autoreactive T cells for apoptosis in vivo. Interestingly several conventional and novel immunotherapeutic approaches like glucocorticosteroids and high-dose antigen therapy induce T cell apoptosis in situ in EAN. A better understanding of immune regulation and its failure in the PNS may help to develop improved, more specific immunotherapies.

Characterizing the mechanisms of progression in multiple sclerosis: evidence and new hypotheses for future directions

Major advancements have been achieved in our ability to diagnose multiple sclerosis (MS) and to commence treatment intervention with agents that can favorably affect the disease course. Although MS exacerbations and the emergence of disability constitute the more conspicuous aspects of the disease process, evidence has confirmed that most of the disease occurs on a constitutive and occult basis. Disease-modifying therapies appear to be modest in the magnitude of their treatment effects, particularly in the progressive stage of the disease. Therapeutic strategies currently used for MS primarily target the inflammatory cascade. Several potential mechanisms appear to be involved in the progression of MS. Characterizing these mechanisms will result in a better understanding of the various forms of the disorder and how to effectively treat its clinical manifestations. It is our objective within this 2-part series on progression in MS to offer both evidence-based observations and hypothesis-driven expert perspectives on what constitutes the cause of progression in MS. We have chosen areas of inquiry that appear to have been most productive in helping us to better conceptualize the landscape of what MS looks like pathologically, immunologically, neuroscientifically, radiographically, and genetically. We have attempted to advance hypotheses focused on a deeper understanding of what contributes to the progression of this illness and to illustrate new technical capabilities that are catalyzing novel research initiatives targeted at achieving a more complete understanding of progression in MS.

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Since 2003 bread and fine bakery products must not contain more than 350 μg Deoxynivalenol (DON). As a prerequisite for the label "Geprüfte Qualität"-Thüringen [proved quality Thuringia] and since coming into force of the respective evaluation prescription a total of 25 breads and 41 fine bakery products was investigated by ELISA with regard of this compound. In the 66 samples of the year 2003 no DON concentrations above the limit were detected and in the preparation period 2001/2002 only one sample exceeded the maximum. In several samples, most narrow to the maximum limit, an additional determination by HPLC was performed which resulted in lower DON-concentrations as compared to the values analyzed by ELISA.

Analyse der Fettsäurenzusammensetzung des Rohfettes von Prüffutter für Schweine (Kurzmitteilung)

Abstract. Title of the paper: Analysis of the fatty acid composition of the raw fat from the feed of pigs which are examined to her performance (short communication) The raw fat of 14 examining feeds from 13 German performance testing centres for pigs was extracted 2001 and analysed for the fatty acid composition by means of gas chromatography. Besides a great variation of the raw fat content (s % = 42) was to state that with 14.4 g/kg feed on average the content of polyunsaturated fatty acids (PUFA) was high. Examinations of the raw fat of wheat, rye and barley showed that the high proportions in linoleic and linolenic acid are brought in the fattening rations primarily by the cereal components. A limitation of the PUFA proportions below 15 g/kg feed therefore doesn't seem to be practicable in the examining feed of performance testing centres for pigs. The additional variation in the fatty acid composition of examining feeds caused by added fats or oils should however be limited according to a better standardization.

Erhebungen zur Fettsäurenzusammensetzung von Rückenfett bei Thüringer Schweinen sowie zum Fett von Thüringer Knackwürsten aus dem Einzelhandel

Abstract. Title of the paper: Examinations to the fatty acid composition of backfat at Thuringian pigs as well as to the fat of Thuringian cracking sausages from the retail trade The fat from the outer back bacon of Thuringian pigs (n = 751) was examined several years with regard to their fatty acid composition. The content of polyunsaturated fatty acids (PUFA) ranged at the backfat from 7.3 to 12.7% and the relationship of the n-6 and n-3 fatty acids varied from 4.4 to 11.3. PUFA contents in the backfat > 12 % were explained by high C18:2 or C18:3 contents of the food. Examination of the fatty acid composition of the fat of 21 fresh cracking sausages from the Thuringian retail trade on a random basis yielded, that the contents of PUFA and linolenic acid ranged from 6.2 to 15.8 % respectively from 0.8 to 2.0 % as well as the quotient of n-6 to n-3 fatty acids varied from 3.6 to 10.3.

Effects of rapeseed-press cake glucosinolates and iodine on the performance, the thyroid gland and the liver vitamin A status of pigs

Rapeseed press cake (per kg DM 181 g EE, 341 g CP and 23.3 mmol glucosinolates) was tested in a long-term experiment with a total of sixty pigs (live weight range 24 to 104 kg). The 3 x 2 factorial design consisted of three rapeseed press cake levels (no rapeseed press cake--control, 75 g or 150 g rapeseed press cake per kg diet) each with two iodine dosages (125 or 250 micrograms supplementary iodine per kg diet). Reduced feed intake and depressed weight gain were found in groups receiving 150 g rapeseed press cake per kg diet, which correspond to 3.2 mmol glucosinolates per kg diet. At an inclusion level of 75 g rapeseed-press cake per kg diet no differences in feed intake and growth intensity were recorded in comparison to the rape feed free control. The rapeseed-press cake diet increased the weight of thyroid gland and liver and decreased the serum thyroxine (T4) concentration. Higher iodine dosage increased the serum T4 concentration of pigs receiving 75 g rapeseed press cake per kg diet (= 1.6 mmol glucosinolates per kg diet) to the level of the control group and retarded the enlargement of the thyroid gland. Intake of rapeseed products lowered the iodine content of the thyroid gland, however, there was no significant difference between groups given 1.6 and 3.2 mmol glucosinolates per kg diet. The vitamin A content of the whole liver and the vitamin A serum concentration were not influenced by the diets tested. However, rapeseed press cake and the glucosinolates, respectively, decreased the vitamin A concentration per gram liver due to the organ enlargement and the resulting dilution effect.