Oral Iptacopan Monotherapy in Paroxysmal Nocturnal Hemoglobinuria

BACKGROUND

Persistent hemolytic anemia and a lack of oral treatments are challenges for patients with paroxysmal nocturnal hemoglobinuria who have received anti-C5 therapy or have not received complement inhibitors. Iptacopan, a first-in-class oral factor B inhibitor, has been shown to improve hemoglobin levels in these patients.

METHODS

In two phase 3 trials, we assessed iptacopan monotherapy over a 24-week period in patients with hemoglobin levels of less than 10 g per deciliter. In the first, anti-C5-treated patients were randomly assigned to switch to iptacopan or to continue anti-C5 therapy. In the second, single-group trial, patients who had not received complement inhibitors and who had lactate dehydrogenase (LDH) levels more than 1.5 times the upper limit of the normal range received iptacopan. The two primary end points in the first trial were an increase in the hemoglobin level of at least 2 g per deciliter from baseline and a hemoglobin level of at least 12 g per deciliter, each without red-cell transfusion; the primary end point for the second trial was an increase in hemoglobin level of at least 2 g per deciliter from baseline without red-cell transfusion.

RESULTS

In the first trial, 51 of the 60 patients who received iptacopan had an increase in the hemoglobin level of at least 2 g per deciliter from baseline, and 42 had a hemoglobin level of at least 12 g per deciliter, each without transfusion; none of the 35 anti-C5-treated patients attained the end-point levels. In the second trial, 31 of 33 patients had an increase in the hemoglobin level of at least 2 g per deciliter from baseline without red-cell transfusion. In the first trial, 59 of the 62 patients who received iptacopan and 14 of the 35 anti-C5-treated patients did not require or receive transfusion; in the second trial, no patients required or received transfusion. Treatment with iptacopan increased hemoglobin levels, reduced fatigue, reduced reticulocyte and bilirubin levels, and resulted in mean LDH levels that were less than 1.5 times the upper limit of the normal range. Headache was the most frequent adverse event with iptacopan.

CONCLUSIONS

Iptacopan treatment improved hematologic and clinical outcomes in anti-C5-treated patients with persistent anemia - in whom iptacopan showed superiority to anti-C5 therapy - and in patients who had not received complement inhibitors. (Funded by Novartis; APPLY-PNH ClinicalTrials.gov number, NCT04558918; APPOINT-PNH ClinicalTrials.gov number, NCT04820530.).

Nonlinear optical properties and carrier recombination lifetime of GaN

Nonlinear optical properties of a selection of gallium nitride samples have been measured using picosecond and nanosecond duration laser pulses at 532 nm. The values of the two-photon absorption coefficient, free carrier absorption cross section, and free carrier refraction cross section are determined along with the recombination lifetime of photogenerated carriers. The effect of hot isostatic pressing on these properties in samples with linear absorption at the band edge due to defects is explored.

High-intensity interval training in cardiac rehabilitation (HIIT or MISS UK): A multi-centre randomised controlled trial

BACKGROUND

There is a lack of international consensus regarding the prescription of high-intensity interval exercise training (HIIT) for people with coronary artery disease (CAD) attending cardiac rehabilitation (CR).

AIM

To assess the clinical effectiveness and safety of low-volume HIIT compared with moderate intensity steady-state (MISS) exercise training for people with CAD.

METHODS

We conducted a multi-centre RCT, recruiting 382 patients from 6 outpatient CR centres. Participants were randomised to twice-weekly HIIT (n = 187) or MISS (n = 195) for 8 weeks. HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. MISS was 20-40 minutes of moderate intensity continuous exercise (60-80% maximum capacity). The primary outcome was the change in cardiorespiratory fitness (peak oxygen uptake, VO2 peak) at 8-week follow-up. Secondary outcomes included cardiovascular disease risk markers, cardiac structure and function, adverse events, and health-related quality of life.

RESULTS

At 8 weeks, VO2  peak improved more with HIIT (2.37 mL.kg-1.min-1; SD, 3.11) compared with MISS (1.32 mL.kg-1.min-1; SD, 2.66). After adjusting for age, sex and study site, the difference between arms was 1.04 mL.kg-1.min-1 (95% CI, 0.38 to 1.69; p = 0.002). Only 1 serious adverse event was possibly related to HIIT.

CONCLUSIONS

In stable CAD, low-volume HIIT improved cardiorespiratory fitness more than MISS by a clinically meaningful margin. Low-volume HIIT is a safe, well tolerated, and clinically effective intervention that produces short-term improvement in cardiorespiratory fitness. It should be considered by all CR programmes as an adjunct or alternative to MISS.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02784873. https://clinicaltrials.gov/ct2/show/NCT02784873.

Novel chimeric monoclonal antibodies that block fentanyl effects and alter fentanyl biodistribution in mice

The prevalence and societal impact of opioid use disorder (OUD) is an acknowledged public health crisis that is further aggravated by the current pandemic. One of the devastating consequences of OUD is opioid overdose deaths. While multiple medications are now available to treat OUD, given the prevalence and societal burden, additional well-tolerated and effective therapies are still needed. To this point, we have developed chimeric monoclonal antibodies (mAb) that will specifically complex with fentanyl and its analogs in the periphery, thereby preventing them from reaching the central nervous system. Additionally, mAb-based passive immunotherapy offers a high degree of specificity to drugs of abuse and does not interfere with an individual’s ability to use any of the medications used to treat OUD. We hypothesized that sequestering fentanyl and its analogs in the periphery will mitigate their negative effects on the brain and peripheral organs. This study is the first report of chimeric mAb against fentanyl and its analogs. We have discovered, engineered the chimeric versions, and identified the selectivity of these antibodies, through in vitro characterization and in vivo animal challenge studies. Two mAb candidates with very high (0.1–1.3 nM) binding affinities to fentanyl and its analogs were found to be effective in engaging fentanyl in the periphery and blocking its effects in challenged animals. Results presented in this work constitute a major contribution in the field of novel therapeutics targeting OUD.

Heart failure with preserved ejection fraction (HFpEF) pathophysiology study (IDENTIFY-HF): rise in arterial stiffness associates with HFpEF with increase in comorbidities

Background

There has been a shift in paradigm proposing that comorbidities play a significant role towards the pathophysiology of the heart failure with preserved ejection fraction (HFpEF) syndrome. Further, HFpEF patients have abnormal macrovascular function, potentially contributing significantly in altered ventricular-vascular coupling in these patients. However, our full understanding of the role of comorbidities, arterial stiffness and it relationship with HFpEF remains incomplete.

Purpose

The IDENTIFY-HF study aims to shed light on the HFpEF pathophysiology and investigates whether gradually increase in arterial stiffness (in addition to ageing) due to increasing common comorbidities, such as hypertension and diabetes, is associated with HFpEF.

Methods

Arterial compliance was assessed in five groups (Groups A to E) matched for age, (≥70 years), sex and renal function: Group A; normal healthy volunteers without major comorbidities (control). Group B; patients with hypertension only. Group C; patients with hypertension and diabetes mellitus only. Group D; patients with HFpEF. Group E; patients with heart failure and reduced ejection fraction (HFrEF); the parallel group. Arterial compliance was assessed using pulse wave velocity (PWV), as the primary outcome measure and was compared between Group A to D. A separate comparison was made between Groups D and E. To avoid confounding factors, participants were asked to omit their morning blood pressure medication and abstain from caffeine for 12 hours prior to the study.

Results

From the 95 volunteers recruited, PWV was obtained in 94 subjects. The mean PWV in group A, B, C, D and E was 10.2-, 12.2-, 13.0-, 13.7- and 10.0 m/s respectively. After adjusting for covariance (age, sex, BMI and renal function), the mean difference between Group A (healthy volunteers) and D (HFpEF) was 2.14 m/s (p=0.023). Whilst the mean difference between the HFpEF and HFrEF group D and E respectively was 2.68 m/s (p=0.003).

Conclusion

Rise in comorbidities increases arterial stiffness, as measured by pulse wave velocity, which in turn significantly associates with HFpEF (p=0.023). It is therefore possible that the HFpEF syndrome may not be due to a primary cardiac pathology but rather an end-result of non-cardiac comorbidities affecting vascular resistance with perhaps some secondary cardiac involvement.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): 1)West Midlands Clinical Research Network, National Institute of Health Research, UK2)Research, Development & Innovation department of the University Hospitals Coventry & Warwickshire NHS Trust (RDI, UHCW), UK.

Real-world evaluation of follow up strategies after implantable cardiac-defibrillator therapies in patients with ventricular tachycardia (REFINE-VT)

Introduction

Implantable cardiac-defibrillators (ICD) can prevent sudden cardiac death but the risk of recurrent ventricular arrhythmia (VA) and ICD therapies persists. Established strategies to minimize such risks include medication optimization, device reprogramming or ventricular tachycardia (VT) catheter ablation (CA). However, the timing and choice of these strategies at ICD follow-up may not be as consistent in the real-world as the regulated conditions of clinical trials. Furthermore, whether these decisions at follow-up are influenced by the type of arrhythmia, ICD therapy or patient characteristics remain unclear.

Purpose

We evaluated ICD follow-up strategies in patients with ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM) to refine the outpatient management of these complex patients and ultimately improve overall patient outcome.

Methods

REFINE-VT is a retrospective study of 514 patients with ICD/CRT-D who attended ICD follow-up between June 2018 to September 2019 at the University Hospital Coventry & Warwickshire (UHCW) tertiary cardiology department. All follow-ups were face-to-face. Patients were divided into 2 groups according to the absence or presence of sustained VA (e.g. >30 seconds of VT and/or appropriate ICD therapy), described as “negative event” and “positive event” groups respectively. The type of strategy employed in response to a positive event were categorized into 4 groups: (1) Medication change only (2) Device programming +/− medication (3) Referral for VT CA (4) No intervention

Results

514 consecutive patients with ICD (52%) or CRT-D (48%) were analysed. Overall mean age was 67±14 years with 79% male patients. ICM was diagnosed in 329 (64%) patient and NICM in 185 (36%). 437 (85%) patients had no significant VA and/or ICD therapy referred to as the negative group. A total of 77 patients (15%) suffered VA and/or ICD therapies, of whom 22 patients (26%) experienced a second event. 31% (n=24) of this positive event group received no preventative strategy (Table 1). We observed an inconsistent approach to the choice of strategies across different types of arrhythmias and ICD therapies. E.g. the odds of intervening were significantly higher if ICD shock was detected compared to anti-tachycardia pacing (OR 8.4, 95% CI 1.7–39.6, p=0.007). Even in patients with two events, the rate of referral for VT ablation and escalation of antiarrhythmics were similarly as low as patients with a single event (Table 2).

Conclusion

This is the first contemporary study that has evaluated how strategies that reduce the risk of recurrent ICD events are executed in a real-world population. We have demonstrated that the decision to intervene and choices of strategy remain inconsistent and partially biased by the type of arrhythmia and ICD therapy at follow-up. This supports the need for an evidence-driven multi-disciplinary VT clinic to refine and standardize our approach to this heterogeneous population.

Funding Acknowledgement

Type of funding sources: None.

Abstract 1249: LP184, a novel alkylating agent, is efficacious in prostate cancer models with DNA damage repair defects

Prostate cancer (CaP) remains the most commonly diagnosed malignancy and the second leading cause of cancer related deaths in men in the US. While the 5-year survival rate for patients with localized CaP is over 99%, it is only 30% for patients with distant metastases. Despite impressive advances in the treatment of metastatic CaP with more efficacious inhibitors along the androgen/androgen receptor axis, eventual development of incurable metastatic Castration Resistant Prostate Cancer (mCRPC) is inevitable, necessitating the development of newer therapeutic strategies. Comprehensive evaluations of CaP genomes from localized and metastatic CaP have revealed that subsets harboring mutations in certain DNA Damage Repair Genes (DDRGs) account for up to 30% of patients. LP184, a novel alkylating agent belonging to the acylfulvene (AF) class is currently in preclinical development, having demonstrated appreciable anticancer activity in multiple prostate tumor models. LP184 exhibits nanomolar potency (20 - 350 nM) against widely used CaP cell lines in 2D culture while having reduced cytotoxicity in a non-tumor prostate epithelial cell line. In CaP cell lines, LP184 turned out equipotent as standard chemotherapeutic Docetaxel, 100-2000 times more potent than another alkylating agent Cisplatin, and 100-9000 times more potent than PARP inhibitor, Olaparib. LP184 is also effective in 3 CaP organoid models 3D cultured from patient-derived xenografts. We hypothesize that LP184 exhibits potent inhibitory effects on CaP cells through a compromised DNA repair milieu of mCRPC due to damaging DDRG mutations in BRCA2, FANCI, ERCC3, ERCC6, FANCG, PALB2 and ATM represented by the in vitro CaP models tested. DNA damage resulting from AF treatment is known to be processed exclusively via transcription coupled nucleotide excision repair. Consistent with this, we observed enhanced LP-184 sensitivity in a cell line model with truncated ERCC3 relative to the otherwise syngeneic parental cell line. Based on Connectivity Map (CMAP) analysis of full transcriptome profiling data on LP184 treatment in selected CaP cell lines, we identified potential drug classes including PARP inhibitors, proteasome inhibitors, topoisomerase inhibitors and MTOR inhibitors that emerged in silico as synergistic with LP184. This approach utilized matching of genes differentially expressed upon LP184 exposure compared to 5000 other small molecules within CMAP. Advancement of LP184, potentially exploiting recurrent and actionable DDRG mutations, is anticipated to be translated into future clinical trials for mCRPC, a lethal CaP that is responsible for ~33,000 deaths/year in the US alone. Given that only a subset of patients responds to any single drug in this advanced CaP stage, LP184 stands out as a unique agent that may complement or synergize with drugs currently used in treatment of mCRPC and improve the outcomes for men with lethal CaP.

Citation Format: Aditya Kulkarni, Partha Banerjee, Umesh Kathad, Kishor Bhatia, Panna Sharma. LP184, a novel alkylating agent, is efficacious in prostate cancer models with DNA damage repair defects [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1249.

Abstract 478: Extracellular vesicle based multi-omics prediction model for the early detection of pancreatic cancer

Introduction: Pancreas cancer (PC) is projected to become the third leading cause of cancer deaths in the US, however there is no screening test in routine clinical use. A minimally invasive test for early detection of PC is a critical unmet clinical need. Extracellular vesicles (EVs) shed into the circulation include a diverse array of surface and cargo biomolecules that can be leveraged as biomarkers for the early detection of PC. We hypothesize that systemic molecular characterization of plasma EVs, secreted by latent yet progressing precursor lesions (PL) of the pancreas, may lead to the development of high accuracy classification algorithms for stratification of patients for the early detection of PC. Herein, we developed a liquid biopsy-based PACE assay (Pancreatic Cancer Exosomics) comprised of a multi-omics (proteomics, metabolomics, and lipidomics) biomarker panel.

Methods: To develop a functional EV-based multi-omics biomarker panel, we performed metabolomics, lipidomics and proteomics analysis of EVs from high quality pre-surgery, fasting plasma samples obtained from patients with early stage pancreatic cancer (IA, IB and IIA) (N= 60), normal control subjects without cancer (N = 50), patients diagnosed with pancreatitis (benign) (N= 39), and early stage colorectal cancer (N=30) as related disease cohorts. For selection of candidate biomarkers, we randomly divided 3/5th of the sample set as discovery and the remainder 2/5th as the test cohort. To consider the effect of potential correlation for predictors, we applied the elastic net penalty to generalized linear model (ELNET). A 100-fold cross-validation approach was used to determine tuning parameters and calibrate the prediction model in the discovery set.

Results: These analyses allowed us to develop a 12 analyte multi-omics panel that could discriminate early stage PC from normal controls (NC) with 98.2% accuracy (Specificity (SP) = 85.2% and Sensitivity (SN) = 71.5%) and 95.4% accuracy (SP = 92.8% and SN = 59.3%) for discovery and validation sets, respectively. A unique aspect of the study design was the inclusion of control cohorts to eliminate non-specific markers. Furthermore, extensive clinical outcome data allowed us to develop multi-analyte predictors of overall survival and progression free survival with high accuracy. Validation of these findings using orthogonal methods is ongoing.

Conclusions: In summary, these preliminary data provide strong support for the development of a liquid biopsy-based EV biomarker panel for the early detection of PC. We believe the positive predictive value (PPV) of this panel can be further improved in conjunction with serum CA 19-9 that is in routine clinical use.

Citation Format: Yaoxiang Li, Keith Unger, Charles Hinzman, Meth Jayatilake, Anton Iliuk, Shivani Bansal, Michael Girgis, Partha Banerjee, John B. Tyburski, Todd Bauer, Amrita K. Cheema. Extracellular vesicle based multi-omics prediction model for the early detection of pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 478.

Abstract 2668: Pancreatic cancer cell extracellular vesicles drive the unfolded protein response in recipient normal pancreas cells

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is projected to become the second leading cause of cancer-related deaths by 2030. The 5-year survival rate remains low, hovering ~9%. A key driver of poor patient outcomes is late-stage diagnosis of disease. Currently, no diagnostics exist to identify indolent disease. A better understanding of the complex tumor microenvironment in PDAC is needed for discerning disease etiology and progression. Extracellular vesicles (EVs) are nanometer sized lipid-bilayer particles released from cells of all tissue types, which carry an array of biomolecules. EVs mediate a myriad of cancer progression events including tumor proliferation, angiogenesis, immune escape, and metastasis. Their role in PDAC tumorigenesis, however, is largely unknown. In this study we report on the effects of PDAC cell derived EVs on normal pancreatic epithelial cells.

Results: We treated normal pancreas cells with pancreas cancer cell derived EVs (cEVs). Global gene expression analysis identified 376 differentially expressed genes (DEGs) enriched for genes in the aminoacyl-tRNA biosynthesis, tRNA aminoacylation, ATF4 and ATF6 signaling pathways. Gene ontology analysis identified enrichment in biological processes associated with endoplasmic reticulum (ER) stress, NF-kB signaling and DNA damage response. Lipid synthesis was severely altered, with decreased expression in several cholesterol, sterol, and acetyl-CoA pathways. Transcription factor analysis identified enrichment of CHOP/DDIT3 target motifs, as well as targets of XBP1, ATF6 and ATF4. Unfolded protein response (UPR) and ER stress genes in our dataset were significantly upregulated, including DDIT3, NFYB, ATF6 and ATF4. We validated upregulation of UPR/ER stress in these cells using qPCR and luciferase activity assays. Multi-omics characterization of EVs isolated from PDAC and normal cell lines showed distinct biochemical profiles. This analysis identified potential mediators of UPR/ER stress enriched in cEVs, including proteins which regulate protein trafficking and ubiquitination, lipid species esterified to palmitic acid and metabolites which regulate tRNA charging.

Conclusions: We show that cEVs induce significant gene expression changes within recipient normal pancreatic cells and likely induce ER stress, leading to an UPR. Long-term UPR/ER stress can impact a variety of cancer hallmarks, including angiogenesis, genome stability, inflammation, metastasis, and drug resistance. ER stress has been shown to mediate progression of pancreatic intraepithelial neoplasia (PanIN) to PDAC. These results highlight a potential role of EVs in mediating cellular messages from pancreatic cancer cells to alter the function of recipient normal cells, aiding disease onset and progression. Further studies are ongoing to identify key mediators within cEVs for the induction of UPR/ER stress.

Citation Format: Charles Phillip Hinzman, Shivani Bansal, Yaoxiang Li, Anton Iliuk, Jose Trevino, Partha Banerjee, Amrita Cheema. Pancreatic cancer cell extracellular vesicles drive the unfolded protein response in recipient normal pancreas cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2668.

Abstract 2740: Effect of pancreatic cancer cell derived extracellularvesicles on the tumor microenvironment

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is one amongst the most lethal malignancies, with a 5 year survival rate of <10%.While the tumor microenvironment in PDAC is highly immunosuppressive, little is known about the mechanisms of immune invasion leading to rapid tumor progression. Hence, in-depth exploration of early cellular and molecular drivers of PDAC is desirable for early and precise diagnosis and to identify new biological targets for developing new therapies. Extracellular vesicles (EVs) are nanometer sized particles that are shed by most tissues/organs and are known to be important mediators of intercellular signaling and molecular transfer. We hypothesized that pancreatic cancer derived EVs may play an important role in mediating the interactions among the tumor and surrounding microenvironment (TME). Given that tumor-associated macrophages (TAMs) are integral components of the TME that can promote tumor progression, tumor invasion, and intravasation to other parts of the body, this study is focused on investigating the role of PDAC derived EVs in macrophages polarization, which in turn would impact tumor cell proliferation and invasion.

Results: EVs were isolated from 6 pancreatic cancer (PaCa) and 2 normal established pancreatic epithelial cell lines. EVs were characterized using nanoparticle tracking (NTA) and immunoblot analysis. LC-MS/MS based shotgun proteomics analyses of EVs revealed that PaCa cell line derived EVs were significantly enriched in potentially immunomodulatory proteins such as S100 calcium-binding protein A4 (S100A4) and human leukocyte antigen-B (HLA-B). However, PaCa cell EVs had significantly less MHC-class-I-related chain A (MICA), a protein important for proper human leukocyte antigen (HLA) function, as compared to normal pancreatic epithelial cell derived EVs. These data suggest that PaCa derived EVs may influence immunomodulation and macrophage function within the tumor microenvironment thereby strengthening our hypothesis. Further experimental studies aimed at delineating the precise mechanism of action of EVs in macrophage polarization is ongoing.

Conclusions: Our finding suggests significant difference among the molecular composition of PaCa derived cargos as compared to and normal cells derived EVs that could be useful in furthering our understanding about pancreatic cancer etiology. Furthermore, the novel insights obtained from these studies may augment the development of biomarkers that can be used for early detection of the disease and improved therapeutics to improve clinical outcomes.

Citation Format: Baldev Singh, Charles Hinzman, Edina Wang, Anton Iliuk, Jose Trevino, Keith Unger, Partha Banerjee, Amrita K. Cheema. Effect of pancreatic cancer cell derived extracellularvesicles on the tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2740.

HEMOPHAGOCYTOSIS SECONDARY TO PHARYNGEAL ABSCESS IN AN IMMUNOCOMPETENT PATIENT (case report)

Background. Hemophagocytosis is a rare, potentially fatal disorder, comprising pancytopenia, liver dysfunction, hepatosplenomegaly, hypertriglyceridemia, and hyperferritinemia presenting as fever, lympha­denopathy and skin rashes. Objective. To attract the clinicians’ attention to a problem of hemophagocytosis in Critical Care management.Methods. Hemophagocytosis secondary to pharyngeal abscess in a 58 year old male is being reported.Results. A 58-year-old immunocompetent patient presenting with hemophagocytosis secondary to pharyngeal abscess, was managed on ventilator and inotropic support, when he developed heathcare-associated urinary tract infection by Escherichia coli and ventilator-associated pneumonia by Acinetobacter baumanii. He developed neutropenic septic shock and multi-organ dysfunction and went through a downhill course leading to demise.Conclusions. Hemophagocytosis remains a sinister entity in modern intensive care despite astute clinical management. Secondary superinfections with opportunistic multidrug resistant pathogens are difficult to treat. A high index of clinical suspicion, aggressive diagnosis and prompt treatment for hemophagocytosis and polymicrobial opportunistic superinfections with multidrug-resistant healthcare-associated pathogens needs to be addressed upfront.

Effect of chronic kidney disease on serum resistin level

BACKGROUND

Chronic Kidney Diseases (CKD) of all etiologies are usually associated with Insulin Resistance (IR). Resistin is also a protein associated with IR. Some studies conducted abroad have shown that resistin level is higher among CKD patients.

OBJECTIVE

To test if serum resistin level is significantly higher in CKD patients compared to normal individuals.

PATIENTS AND METHODS

96 CKD patients and 97 normal individuals were included in the study. Written informed consent was obtained from every individual.

RESULTS

Serum resistin level was higher in CKD patients compared to control subjects. The difference in serum resistin level between two groups was statistically significant.

CONCLUSION

Our study is probably the first study in India comparing serum resistin levels of CKD patients vis-à-vis control subjects. Further cellular research may be needed to explore this relation.

Colossal dielectric permittivity in Co-doped ZnO ceramics prepared by a pressure-less sintering method

Dielectric properties and impedance spectroscopic studies of single phase Zn_1−xCo_xO (0 ≤ x ≤ 0.05) ceramics, synthesized by a pressure-less solid state reaction method, have been carried out to investigate the origin of colossal dielectric permittivity (CP), ε′ ∼ 10⁵, in a wide frequency (2 × 10¹–2 × 10⁶ Hz) range.

Evaluation of finite difference and FFT-based solutions of the transport of intensity equation

A finite difference method is proposed for solving the transport of intensity equation. Simulation results show that although slower than fast Fourier transform (FFT)-based methods, finite difference methods are able to reconstruct the phase with better accuracy due to relaxed assumptions for solving the transport of intensity equation relative to FFT methods. Finite difference methods are also more flexible than FFT methods in dealing with different boundary conditions.

Cord blood NK cells engineered to express IL-15 and a CD19-targeted CAR show long-term persistence and potent antitumor activity

Chimeric antigen receptors (CARs) have been used to redirect the specificity of autologous T cells against leukemia and lymphoma with promising clinical results. Extending this approach to allogeneic T cells is problematic as they carry a significant risk of graft-versus-host disease (GVHD). Natural killer (NK) cells are highly cytotoxic effectors, killing their targets in a non-antigen-specific manner without causing GVHD. Cord blood (CB) offers an attractive, allogeneic, off-the-self source of NK cells for immunotherapy. We transduced CB-derived NK cells with a retroviral vector incorporating the genes for CAR-CD19, IL-15 and inducible caspase-9-based suicide gene (iC9), and demonstrated efficient killing of CD19-expressing cell lines and primary leukemia cells in vitro, with marked prolongation of survival in a xenograft Raji lymphoma murine model. Interleukin-15 (IL-15) production by the transduced CB-NK cells critically improved their function. Moreover, iC9/CAR.19/IL-15 CB-NK cells were readily eliminated upon pharmacologic activation of the iC9 suicide gene. In conclusion, we have developed a novel approach to immunotherapy using engineered CB-derived NK cells, which are easy to produce, exhibit striking efficacy and incorporate safety measures to limit toxicity. This approach should greatly improve the logistics of delivering this therapy to large numbers of patients, a major limitation to current CAR-T-cell therapies.

Structural and functional diversity of nonapeptide hormones from an evolutionary perspective: A review

The article presents an overview of the comparative distribution, structure and functions of the nonapeptide hormones in chordates and non chordates. The review begins with a historical preview of the advent of the concept of neurosecretion and birth of neuroendocrine science, pioneered by the works of E. Scharrer and W. Bargmann. The sections which follow discuss different vertebrate nonapeptides, their distribution, comparison, precursor gene structures and processing, highlighting the major differences in these aspects amidst the conserved features across vertebrates. The vast literature on the anatomical characteristics of the nonapeptide secreting nuclei in the brain and their projections was briefly reviewed in a comparative framework. Recent knowledge on the nonapeptide hormone receptors and their intracellular signaling pathways is discussed and few grey areas which require deeper studies are identified. The sections on the functions and regulation of nonapeptides summarize the huge and ever increasing literature that is available in these areas. The nonapeptides emerge as key homeostatic molecules with complex regulation and several synergistic partners. Lastly, an update of the nonapeptides in non chordates with respect to distribution, site of synthesis, functions and receptors, dealt separately for each phylum, is presented. The non chordate nonapeptides share many similarities with their counterparts in vertebrates, pointing the system to have an ancient origin and to be an important substrate for changes during adaptive evolution. The article concludes projecting the nonapeptides as one of the very first common molecules of the primitive nervous and endocrine systems, which have been retained to maintain homeostatic functions in metazoans; some of which are conserved across the animal kingdom and some are specialized in a group/lineage-specific manner.

Submandibular intubation in awake patient of panfacial trauma

Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems.

Comparative Proteomics Reveals Dysregulated Mitochondrial O-GlcNAcylation in Diabetic Hearts

O-linked β-N-acetylglucosamine (O-GlcNAc), a post-translational modification on serine and threonine residues of many proteins, plays crucial regulatory roles in diverse biological events. As a nutrient sensor, O-GlcNAc modification (O-GlcNAcylation) on nuclear and cytoplasmic proteins underlies the pathology of diabetic complications including cardiomyopathy. However, mitochondrial O-GlcNAcylation, especially in response to chronic hyperglycemia in diabetes, has been poorly explored. We performed a comparative O-GlcNAc profiling of mitochondria from control and streptozotocin (STZ)-induced diabetic rat hearts by using an improved β-elimination/Michael addition with isotopic DTT reagents (BEMAD) followed by tandem mass spectrometric analysis. In total, 86 mitochondrial proteins, involved in diverse pathways, were O-GlcNAcylated. Among them, many proteins have site-specific alterations in O-GlcNAcylation in response to diabetes, which suggests that protein O-GlcNAcylation is a novel layer of regulation mediating adaptive changes in mitochondrial metabolism during the progression of diabetic cardiomyopathy.

A dynamic landscape of allergen associations in delayed-type cutaneous hypersensitivity

BACKGROUND

Delayed-type hypersensitivity represents a significant clinical and public health challenge. Patients undergoing patch testing may exhibit positive reactions to more than one allergen. It is recognized that reactions to specific pairs of allergens are associated, reflecting a combination of exposure patterns and structural similarity.

OBJECTIVES

To explore the influence of time of testing, age, sex and atopy status on allergen pair associations in a series of 45 110 consecutive patients tested over 30 years.

METHODS

Patch test records of all patients undergoing testing with a modified European baseline series between 1985 and 2014 were retrieved from a database at St John's Institute of Dermatology. Reactions were read on days 2 and 4. For each allergen it was recorded whether the allergen was tested and whether the result was positive or negative.

RESULTS

This is the largest reported study of patch test allergen pair relationships. Our analysis shows a high degree of variability in allergen pair associations. Rigorous statistical analysis reveals a large number of differences between groups, including a significant increase in the association between formaldehyde and multiple formaldehyde-releasing preservatives over the study period, in addition to pair associations with cobalt and formaldehyde-releasing preservatives. These were present to a significantly greater extent in men than in women.

CONCLUSIONS

These observations extend our understanding of cutaneous allergy, with implications for both clinical practice and mechanisms of cutaneous hypersensitivity.