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Karaterzi S, Tönshoff B, Ahlenstiel-Grunow T, Baghai M, Beck B, Büscher A, Eifler L, Giese T, Lezius S, Müller C, Oh J, Zapf A, Weber LT, Pape L. A multi-center interventional study to assess pharmacokinetics, effectiveness, and tolerability of prolonged-release tacrolimus after pediatric kidney transplantation: study protocol for a prospective, open-label, randomized, two-phase, two-sequence, single dose, crossover, phase III b trial. Front Nephrol 2024; 4:1331510. [PMID: 38444519 PMCID: PMC10912931 DOI: 10.3389/fneph.2024.1331510] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
Background Tacrolimus, a calcineurin inhibitor (CNI), is currently the first-line immunosuppressive agent in kidney transplantation. The therapeutic index of tacrolimus is narrow due to due to the substantial impact of minor variations in drug concentration or exposure on clinical outcomes (i.e., nephrotoxicity), and it has a highly variable intra- and inter-individual bioavailability. Non-adherence to immunosuppressants is associated with rejection after kidney transplantation, which is the main cause of long-term graft loss. Once-daily formulations have been shown to significantly improve adherence compared to twice-daily dosing. Envarsus®, the once-daily prolonged-release formulation of tacrolimus, offers the same therapeutic efficacy as the conventional twice-daily immediate-release tacrolimus formulation (Prograf®) with improved bioavailability, a more consistent pharmacokinetic profile, and a reduced peak to trough, which may reduce CNI-related toxicity. Envarsus® has been approved as an immunosuppressive therapy in adults following kidney or liver transplantation but has not yet been approved in children. The objective of this study is to evaluate the pharmacokinetic profile, efficacy, and tolerability of Envarsus® in children and adolescents aged ≥ 8 and ≤ 18 years to assess its potential role as an additional option for immunosuppressive therapy in children after kidney transplantation. Methods/design The study is designed as a randomized, prospective crossover trial. Each patient undergoes two treatment sequences: sequence 1 includes 4 weeks of Envarsus® and sequence 2 includes 4 weeks of Prograf®. Patients are randomized to either group A (sequence 1, followed by sequence 2) or group B (sequence 2, followed by sequence 1). The primary objective is to assess equivalency between total exposure (of tacrolimus area under the curve concentration (AUC0-24)), immediate-release tacrolimus (Prograf®) therapy, and prolonged-release tacrolimus (Envarsus®) using a daily dose conversion factor of 0.7 for prolonged- versus immediate-release tacrolimus. Secondary objectives are the assessment of pharmacodynamics, pharmacogenetics, adherence, gut microbiome analyses, adverse events (including tacrolimus toxicity and biopsy-proven rejections), biopsy-proven rejections, difference in estimated glomerular filtration rate (eGFR), and occurrence of donor-specific antibodies (DSAs). Discussion This study will test the hypothesis that once-daily prolonged-release tacrolimus (Envarsus®) is bioequivalent to twice-daily intermediate-release tacrolimus after pediatric kidney transplantation and may reduce toxicity and facilitate medication adherence. This novel concept may optimize immunosuppressive therapy for more stable graft function and increased graft survival by avoiding T-cell mediated and/or antibody-mediated rejection due to improved adherence. In addition, the study will provide data on the pharmacodynamics and pharmacogenetics of prolonged-release tacrolimus in children and adolescents. Clinical Trial Registration EUDRA-CT 2019-003710-13 and ClinicalTrial.gov, identifier NCT06057545.
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Affiliation(s)
- Sinem Karaterzi
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | | | - Maral Baghai
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Bodo Beck
- Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Anja Büscher
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
| | - Lisa Eifler
- Children’s and Adolescents’ Hospital, Pediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | - Thomas Giese
- Department of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Carsten Müller
- Pharmacology at the Laboratory Diagnostics Centre, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jun Oh
- Department of Pediatric Nephrology and Gastroenterology, University Hospital Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Lutz T. Weber
- Children’s and Adolescents’ Hospital, Pediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
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Martin-Higueras C, Borghese L, Torres A, Fraga-Bilbao F, Santana-Estupiñán R, Stefanidis CJ, Tory K, Walli A, Gondra L, Kempf C, Gessner M, Habbig S, Eifler L, Schmitt CP, Rüdel B, Bartram MP, Beck BB, Hoppe B. Multicenter Long-Term Real World Data on Treatment With Lumasiran in Patients With Primary Hyperoxaluria Type 1. Kidney Int Rep 2024; 9:114-133. [PMID: 38312792 PMCID: PMC10831356 DOI: 10.1016/j.ekir.2023.10.004] [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: 07/14/2023] [Revised: 08/28/2023] [Accepted: 10/02/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The RNA interference (RNAi) medication lumasiran reduces hepatic oxalate production in primary hyperoxaluria type 1 (PH1). Data outside clinical trials are scarce. Methods We report on retrospectively and observationally obtained data in 33 patients with PH1 (20 with preserved kidney function, 13 on dialysis) treated with lumasiran for a median of 18 months. Results Among those with preserved kidney function, mean urine oxalate (Uox) decreased from 1.88 (baseline) to 0.73 mmol/1.73 m2 per 24h after 3 months, to 0.72 at 12 months, and to 0.65 at 18 months, but differed according to vitamin B6 (VB6) medication. The highest response was at month 4 (0.55, -70.8%). Plasma oxalate (Pox) remained stable over time. Glomerular filtration rate increased significantly by 10.5% at month 18. Nephrolithiasis continued active in 6 patients, nephrocalcinosis ameliorated or progressed in 1 patient each. At last follow-up, Uox remained above 1.5 upper limit of normal (>0.75 mmol/1.73 m2 per 24h) in 6 patients. Urinary glycolate (Uglyc) and plasma glycolate (Pglyc) significantly increased in all, urine citrate decreased, and alkali medication needed adaptation. Among those on dialysis, mean Pox and Pglyc significantly decreased and increased, respectively after monthly dosing (Pox: 78-37.2, Pglyc: 216.4-337.4 μmol/l). At quarterly dosing, neither Pox nor Pglyc were significantly different from baseline levels. An acid state was buffered by an increased dialysis regimen. Systemic oxalosis remained unchanged. Conclusion Lumasiran treatment is safe and efficient. Dosage (interval) adjustment necessities need clarification. In dialysis, lack of Pox reduction may relate to dissolving systemic oxalate deposits. Pglyc increment may be a considerable acid load requiring careful consideration, which definitively needs further investigation.
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Affiliation(s)
- Cristina Martin-Higueras
- German Hyperoxaluria Center, c/o Kindernierenzentrum Bonn, Germany
- Institute of Biomedical Technology, University of La Laguna, Tenerife, Spain
| | | | - Armando Torres
- Institute of Biomedical Technology, University of La Laguna, Tenerife, Spain
- Department of Nephrology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Fátima Fraga-Bilbao
- Department of Pediatrics, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Santana-Estupiñán
- Department of Nephrology, Hospital Universitario de Gran Canaria Doctor Negrín, Gran Canaria, Spain
| | | | - Kálmán Tory
- Pediatric Center, MTA Center of Excellence, Semmelweis University; Budapest, Hungary & MTA-SE Lendulet Nephrogenetic Laboratory, Hungarian Academy of Sciences, Budapest, Hungary
| | - Adam Walli
- Wisplinghoff Laboratory, Cologne, Germany
| | - Leire Gondra
- Pediatric Nephrology Department, Cruces University Hospital, UPV/EHU, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Caroline Kempf
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Disorders, Charité Universitätsmedizin Berlin, Germany
| | | | - Sandra Habbig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Lisa Eifler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Claus P. Schmitt
- Division of Pediatric Nephrology, University Hospital Heidelberg, Germany
| | | | - Malte P. Bartram
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Bodo B. Beck
- Institute of Human Genetics, University Hospital Cologne, Germany
| | - Bernd Hoppe
- German Hyperoxaluria Center, c/o Kindernierenzentrum Bonn, Germany
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Kohl S, Eifler L. [A 15-year-old girl with swollen and reddened toes]. Monatsschr Kinderheilkd 2021; 170:105-109. [PMID: 33903780 PMCID: PMC8059425 DOI: 10.1007/s00112-021-01190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- S. Kohl
- Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln, Kerpener Str. 62, 50937 Köln, Deutschland
| | - L. Eifler
- Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln, Kerpener Str. 62, 50937 Köln, Deutschland
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Wagner IV, Klöting N, Savchuk I, Eifler L, Kulle A, Kralisch-Jäcklein S, Dötsch J, Hiort O, Svechnikov K, Söder O. Diabetes Type 1 Negatively Influences Leydig Cell Function in Rats, Which is Partially Reversible By Insulin Treatment. Endocrinology 2021; 162:6122542. [PMID: 33507237 DOI: 10.1210/endocr/bqab017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Indexed: 12/29/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is associated with impaired spermatogenesis and lower testosterone levels and epididymal weight. However, the underlying processes in the testis are unknown and remain to be elucidated. Therefore, the present study focused on the effects of T1DM on testicular function in a spontaneously diabetic rat model. BB/OKL rats after diabetes manifestation were divided into 3 groups: those without insulin treatment and insulin treatment for a duration of 2 and of 6 weeks. Anthropometrical data, circulating levels of gonadotrophins, testosterone, and inhibin B were measured. Intratesticular testosterone, oxidative stress, inflammation, and apoptosis were analyzed. Key enzymes of steroidogenesis were evaluated in the testis. Untreated diabetic rats had significantly lower serum follicle-stimulating hormone and luteinizing hormone levels. Serum and intratesticular testosterone levels significantly decreased in untreated diabetic rats compared to healthy controls. Key markers of Leydig cell function were significantly downregulated at the RNA level: insulin-like factor 3 (Insl3) by 53% (P = .006), Star by 51% (P = .004), Cyp11A1 by 80% (P = .003), 3Beta-Hsd2 by 61% (P = .005), and Pbr by 52% (P = .002). In the insulin-treated group, only Cyp11A1 and 3Beta-Hsd2 transcripts were significantly lower. Interestingly, the long-term insulin-treated group showed significant upregulation of most steroidogenic enzymes without affecting testosterone levels. Tumor necrosis factor α and apoptosis were significantly increased in the long-term insulin-treated rats. In conclusion T1DM, with a severe lack of insulin, has an adverse action on Leydig cell function. This is partially reversible with well-compensated blood glucose control. Long-term T1DM adversely affects Leydig cell function because of the process of inflammation and apoptosis.
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Affiliation(s)
- Isabel Viola Wagner
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Nora Klöting
- Integrated Research and Treatment Center (IFB Adiposity Diseases), Department of Medicine, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig, Leipzig, Germany
| | - Iuliia Savchuk
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Eifler
- Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Alexandra Kulle
- University Hospital Kiel, Hormone Center for Pediatric Endocrinology Laboratory, Kiel, Germany
| | - Susan Kralisch-Jäcklein
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Jörg Dötsch
- Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Konstantin Svechnikov
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Olle Söder
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Eifler L, Hoffmann A, Wagner IV, Klöting N, Sahlin L, Ebert T, Jessnitzer B, Lössner U, Stumvoll M, Söder O, Fasshauer M, Kralisch S. Leptin restores markers of female fertility in lipodystrophy. Biochim Biophys Acta Mol Basis Dis 2018; 1864:3292-3297. [DOI: 10.1016/j.bbadis.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/21/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022]
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von Knethen A, Eifler L, Kuchler L, Heeg A, Heide H, Wittig I, Maier T, Steinhilber D, Brüne B. 5-Lipoxygenase contributes to PPARγ activation in macrophages in response to apoptotic cells. Crit Care 2012. [PMCID: PMC3504884 DOI: 10.1186/cc11770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Matalgah MM, Knopp J, Eifler L. Geometric approach for designing optical binary amplitude and binary phase-only filters. Appl Opt 1998; 37:8233-8246. [PMID: 18301645 DOI: 10.1364/ao.37.008233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An analytic solution for real optimal filters is known, and the special case of optimal binary phase-only filters can be solved by a fast binning algorithm but no analytic solution is known. We establish a geometric solution for the design of optimal binary amplitude filters (OBAF's) and optimal binary phase-only filters (OBPOF's) for any object. The optimal filter is found in terms of maximizing the field strength at the origin in the correlation plane. We found that it is possible to construct a unique convex polygon by using an ordered set of phasors from the filter object's Fourier transform. This process leads eventually to an exact solution for the filter-design problem. We show that the maximum distance across the polygon divides the phasors into two groups: For the OBAF, it determines the group that is passed or blocked; for the OBPOF, it determines which group is passed with a zero or a pi phase shift. The shape of the convex polygon gives qualitative information on the criticalness and the tightness needed in the design process. It provides good insight into the binning-process algorithm and permits us to bound the error in the binning process. Design examples through computer simulation and applications in fingerprint identification are presented.
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