Reversible Albumin-Binding GH Possesses a Potential Once-Weekly Treatment Profile in Adult Growth Hormone Deficiency

CONTEXT

NNC0195-0092 is a reversible, albumin-binding GH derivative, developed for once-weekly administration.

OBJECTIVES

The objective of the study was to evaluate safety, local tolerability, pharmacodynamics, and pharmacokinetics of multiple, once-weekly doses of NNC0195-0092, compared with daily GH.

DESIGN AND SETTING

This was a phase 1, randomized, open-label, active-controlled, multiple-dose, dose-escalation trial.

PATIENTS

Thirty-four GH-treated adult subjects (male, n = 25) with GH deficiency participated in the study.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Subjects were sequentially assigned into four cohorts of eight subjects, randomized within each cohort (3:1) to once-weekly NNC0195-0092 (n = 6) for 4 weeks (0.02, 0.04, 0.08, and 0.12 mg/kg) or daily injections of Norditropin NordiFlex (n = 2) for 4 weeks with a dose replicating the pretrial dose of somatropin. A safety assessment was performed prior to initiating treatment at the next dose level of NNC0195-0092. Daily GH treatment was discontinued 14 days before the trial start. Blood samples were drawn for assessment of safety, pharmacokinetics, pharmacodynamics (IGF-1 and IGF-binding protein-3) profiles, and immunogenicity studies.

RESULTS

Numbers of adverse events were similar at the dose levels of 0.02, 0.04, and 0.08 mg/kg NNC0195-0092 vs daily injections of Norditropin NordiFlex, whereas the number of adverse events was greater at the highest dose level of NNC0195-0092 (0.12 mg/kg). NNC0195-0092 (area under the curve[0-168h]) and peak plasma concentration) increased in a dose-dependent manner, and a dose-dependent increase in IGF-1 levels was observed. IGF-1 profiles were elevated for at least 1 week, and for the 0.02-mg/kg and 0.04-mg/kg NNC0195-0092 doses, the observed IGF-1 levels were similar to the levels for the active control group.

CONCLUSION

Four once-weekly doses of NNC0195-0092 (dose range 0.02-0.12 mg/kg) administered to adult patients with GH deficiency were well tolerated, and IGF-1 profiles were consistent with a once-weekly treatment profile. No clinically significant safety and tolerability signals causally related to NNC0195-0092 were identified, nor were any immunogenicity concerns revealed.

Fresh muscle fiber fragments on a scaffold in rats-a new concept in urogynecology?

OBJECTIVE

To investigate if a synthetic, biodegradable scaffold with either autologous in vitro cultured muscle-derived cells or autologous fresh muscle fiber fragments could be used for tissue repair.

STUDY DESIGN

Twenty scaffolds with muscle-derived cells and 20 scaffolds with muscle fiber fragments were implanted subcutaneously on the abdomen of rats, 2 in each rat, and examined after 3 weeks (10 of each preparation) and 8 weeks (10 of each preparation). Immonohistochemistry and histopathology was undertaken for assessment of growth pattern and biocompatibility, respectively.

RESULTS

At 3 weeks, both muscle-derived cells and muscle fiber fragments could be identified. At 8 weeks, the muscle fiber fragments generated fragmented, striated muscle tissue in 6 of 10 explants, whereas the muscle-derived cells and all scaffolds had vanished.

CONCLUSION

Autologous fresh muscle fiber fragments on a biodegradable scaffold seem useful for tissue repair. This study introduces a promising new concept with possible implications for the surgical reconstruction of pelvic organ prolapse.

Asphyxia-related risk factors and their timing in spastic cerebral palsy

OBJECTIVE

To investigate the association of asphyxia-related conditions (reducing blood flow or blood oxygen levels in the fetus) with spastic cerebral palsy (CP) considering different gestational age groups and the timing of risk.

DESIGN

Population-based case-control study.

SETTING

Danish Cerebral Palsy Register in eastern Denmark and Danish Medical Birth Register.

POPULATION OR SAMPLE

271 singletons with spastic CP and 217 singleton controls, frequency matched by gestational age group, born 1982-1990 in eastern Denmark.

METHODS

Data were abstracted from medical records, and a priori asphyxia-related conditions and other risk factors were selected for analysis. Each factor was classified according to the time at which it was likely to first be present.

MAIN OUTCOME MEASURES

Spastic CP.

RESULTS

Placental and cord complications accounted for the majority of asphyxia conditions. In multivariate analysis, placental infarction was significantly associated with a four-fold increased risk for spastic quadriplegia and cord around the neck was significantly associated with a three-fold increased risk for spastic CP overall. The combination of placental infarction and being small for gestational age (SGA) afforded an especially high risk for spastic quadriplegia. Placental and cord complications were present in 21% of cases and 12% of controls.

CONCLUSIONS

The risk for spastic quadriplegia from placental infarction may be linked in some cases with abnormal fetal growth (17% of all children with spastic quadriplegia and 3% of control children both had an infarction and were SGA) -- suggesting an aetiologic pathway that encompasses both factors. The risk for spastic CP from cord around the neck is not accounted for by other prepartum or intrapartum factors we examined. Considering the relative timing of risk factors provides a useful framework for studies of CP aetiology.

Cerebral palsy among children born after in vitro fertilization: the role of preterm delivery--a population-based, cohort study

OBJECTIVE

Our aim was to assess the incidence of cerebral palsy among children conceived with in vitro fertilization and children conceived without in vitro fertilization.

METHODS

A population-based, cohort study, including all live-born singletons and twins born in Denmark between January 1, 1995, and December 31, 2000, was performed. Children conceived with in vitro fertilization (9255 children) were identified through the In Vitro Fertilization Register; children conceived without in vitro fertilization (394,713) were identified through the Danish Medical Birth Register. Cerebral palsy diagnoses were obtained from the National Register of Hospital Discharges. The main outcome measure was the incidence of cerebral palsy in the in vitro fertilization and non-in vitro fertilization groups.

RESULTS

Children born after in vitro fertilization had an increased risk of cerebral palsy; these results were largely unchanged after adjustment for maternal age, gender, parity, small-for-gestational age status, and educational level. The independent effect of in vitro fertilization vanished after additional adjustment for multiplicity or preterm delivery. When both multiplicity and preterm delivery were included in the multivariate models, preterm delivery remained associated strongly with the risk of cerebral palsy.

CONCLUSIONS

The large proportions of preterm deliveries with in vitro fertilization, primarily for twins but also for singletons, pose an increased risk of cerebral palsy.

Psychic vulnerability and the associated risk for cancer

BACKGROUND

Psychic vulnerability has been associated with a number of physical symptoms and diseases. This study was designed to estimate the incidence of cancer in a random sample of persons in the general Danish population in relation to a personality characteristic measured by the Test of Psychic Vulnerability.

METHODS

The authors examined the cancer incidence in a cohort of 5136 randomly sampled persons age > 25 years living in Copenhagen County, Denmark. The responses to questionnaires and the results of examinations, including the Test of Psychic Vulnerability, were collected during 1982-1984 and during 1991-1992. The observed numbers of cancers were compared with the numbers that would have been expected if the cohort members had experienced the same risk of cancer as the population of Copenhagen County. Regression analyses were performed with the Cox proportional hazards model to adjust for well-known risk factors for cancer.

RESULTS

A total of 403 cancers were observed, and 412.02 were expected, yielding a standardized incidence ratio of 0.98 (95% confidence interval [95% CI], 0.88-1.19). The authors did not observe a significant increase in the risk of site specific cancers. The risk for cancer was not influenced by the type of vulnerability in a multivariate analysis (hazards ratio, 1.16; 95% CI, 0.85-1.57).

CONCLUSIONS

The authors found no increased risk for cancer among psychically vulnerable persons compared with nonvulnerable persons; however, the results indicate that behavior and certain life-style factors may be determined by personality, which, in turn, may determine the risk for cancer.

[Description of a group of psychiatric patients difficult to place]

INTRODUCTION

There are long-term patients in psychiatric hospitals, who are often referred to as new long-stay patients: the heavy users consumers of psychiatric services and difficult-to-place patients.

MATERIAL AND METHOD

Social characteristics, diagnosis, need for care, function, and admission patterns were compared in a group of heavy user patients (N = 39) and a group of difficult-to-place patients (N = 14).

RESULTS AND DISCUSSION

The difficult-to-place patients were more often men, more often had a diagnosis of schizophrenia, had a lower socio-economic status, and lower GAF scores. The difficult-to-place patients rated the same amount of need for care as did the heavy users, but were assessed by the staff to have a greater need for care. The results support the view that the difficult-to-place patients comprise a distinct group. Services for the difficult-to-place patients must combine highly differentiated care with few demands and greater tolerance with respect to problem behaviour.

[The staff's knowledge of patients' social function and needs--in connection with discharge planning]

The aim of the study was to assess the staff's knowledge about the social functioning and needs of the patients. A cross-sectional study interviewing 48 staff members using the Camberwell Assessment of Need--CAN was carried out. In nine of CAN's 26 areas more than 5% of the staff did not know if the patient had a problem. Among the patients with a problem more than 5% of the staff could not assess the need for care in four areas. The staff generally had a good knowledge concerning the patients' need for care. CAN seem to be a relevant instrument for the purpose of discharge planning.

Sirius red and acid fuchsin staining mechanisms

The purpose of the study was to investigate the staining mechanism of acid fuchsin and Sirius red. Acid (poly-glutamic acid), neutral (poly-hydroxyproline) and basic (poly-arginine, poly-histidine, poly-lysine) poly-amino acids, collagen types I, II and III, and arginine- and lysine-containing histones were used as test substances applied to nitrocellulose membranes as dot blots. Five micrometer sections of granulation tissue on slides were tested in parallel. Some dots and sections were treated with chloramine-T before staining with acid fuchsin and Sirius red and some with 1 M NaOH after staining. The acid and neutral poly-amino acids were not stained, but the basic amino acids polylysine and poly-arginine, poly-amino acids containing these basic amino acids and the histones and the collagens exhibited intense staining. Oxidative deamination by chloramine-T abolished the staining and 1 M NaOH removed the staining except in the case of poly-arginine. Tissue sections treated in the same way showed a considerable decrease in staining after oxidative deamination with chloramine-T; in particular, the staining of the smaller fibers was abolished. The staining was totally removed by destaining with 1 M NaOH. Therefore, acid fuchsin and Sirius red are not selectively bound to collagen; they are also bound to other proteins containing basic amino acids, and staining to a large extent is influenced by electrostatic forces. The staining seems not to be selective for collagen, and one must account for this when quantitative conclusions are drawn from collagen methods using these stains.