Incidence of interstitial lung disease in patients with breast cancer: a nationwide database study in Japan

Aim: This study estimated the incidence of moderate-to-severe drug-induced interstitial lung disease (ILD) among patients with breast cancer in Japan. Methods: We analyzed a large nationwide database of patients with breast cancer treated with anticancer therapies between 2009 and 2022. ILD was identified using diagnostic codes and treatment records. Results: Of the 81,601 patients, 1042 developed ILD requiring corticosteroids, corresponding to an incidence rate of 1.41 per 100 person-years. The incidence varied across years and treatment regimens. Most ILD incidents occurred within the initial 90-day period post-anticancer therapy initiation. Conclusion: Increase in ILD cases and potential risk variations among treatments underline the importance of continued monitoring, especially during treatment onset, and ILD management in patients with breast cancer undergoing therapy.

A Single-Dose, Open-Label, Randomized, Two-Way Crossover Study in Healthy Japanese Participants to Evaluate the Bioequivalence and the Food Effect on the Pharmacokinetics of Daprodustat

Daprodustat is a prolyl hydroxylase inhibitor that stimulates erythropoiesis in a manner similar to the natural response to hypoxia, whereby inhibition of hypoxia inducible factor (HIF) prolyl-4-hydroxylases by daprodustat ultimately results in increased levels of HIF-responsive genes. Daprodustat is under development as an emerging new class of agents for the treatment of anemia associated with chronic kidney disease (CKD). This was a single-center, single-dose, open-label, randomized, 2-way crossover study in healthy Japanese male participants consisting of 2 parts. The primary objective was to evaluate the bioequivalence (BE) between daprodustat tablet strengths (part 1) and to evaluate the food effect on the pharmacokinetics (PK) of daprodustat (part 2). A total of 64 healthy Japanese male participants were enrolled; 52 participants were included in part 1 and 12 in part 2. BE was demonstrated between the daprodustat 2-mg tablet and the daprodustat 4-mg tablet. A standard CKD meal did not have a large effect on the PK parameters of daprodustat after a single oral dose of daprodustat 4 mg. Administration of single oral doses of daprodustat 4 mg was generally well tolerated in the healthy Japanese participants, and no new safety signals were identified without regard to food.

Efficacy and Safety of Daprodustat Compared with Darbepoetin Alfa in Japanese Hemodialysis Patients with Anemia: A Randomized, Double-Blind, Phase 3 Trial

BACKGROUND AND OBJECTIVES

Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates genes related to iron metabolism. The efficacy (noninferiority) and safety of daprodustat compared with standard therapy (darbepoetin alfa) was evaluated.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This was a randomized, phase 3, double-blind, active-control study in Japanese patients receiving hemodialysis with anemia of CKD. Participants' treatment was switched from current erythropoiesis-stimulating agents (ESAs) to daprodustat 4 mg once daily or darbepoetin alfa 10-60 μg once weekly (on the basis of the prestudy ESA dose). Dose was adjusted every 4 weeks for daprodustat or every 2 weeks for darbepoetin alfa, according to a protocol-specified algorithm. The primary end point was mean hemoglobin during weeks 40-52 in the intent-to-treat population.

RESULTS

Of 332 participants screened, 271 participants were randomized (safety evaluation: 271 participants; efficacy evaluation: 267 intent-to-treat population). The mean hemoglobin during weeks 40-52 were maintained within the target range in both groups (10.9 g/dl [95% confidence interval (95% CI), 10.8 to 11.0] for daprodustat, and 10.8 g/dl [95% CI, 10.7 to 11.0] for darbepoetin alfa). Daprodustat was noninferior to darbepoetin alfa, as the lower bound of the confidence interval for the treatment difference (0.1 g/dl; 95% CI, -0.1 to 0.2 g/dl) was greater than the noninferiority criterion of -1.0 g/dl. For most participants, hemoglobin was maintained within the target range (10.0-12.0 g/dl) during weeks 40-52 (88% daprodustat; 90% darbepoetin alfa). Geometric mean hepcidin levels decreased more at week 52 with daprodustat (-37%; 95% CI, -49 to -23) than with darbepoetin alfa (-20%; 95% CI, -36 to -1), and an increase in total iron-binding capacity was observed in the daprodustat group. Frequency of adverse events were generally similar between daprodustat and darbepoetin alfa.

CONCLUSIONS

Oral daprodustat was noninferior to darbepoetin alfa as measured by mean hemoglobin over weeks 40-52 in Japanese patients receiving hemodialysis switched from ESAs.

CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER

201754, Clinicaltrials.gov, NCT02969655.

Archaeal lipids forming a low energy-surface on air-water interface

Archaea or archaebacteria are the microorganism living in extreme environments such as hot springs and salt lakes. The membrane is featured universally by lipids which possess saturated polyisoprenoid chains in the hydrophobic moiety. This paper concerns the surface properties of Langmuir membranes made of archaeal lipid models (AL) bearing a phytanyl group or (3RS, 7R, 11R)-3,7,11,15-tetramethylhexadecyl group. All of the AL provide a Langmuir membrane on an air-water interface with an abnormally low surface tension (32-37 mN/m at 20-70 degrees C), while the conventional lipids having n-alkyl chains give membranes of 54-56 mN/m. The abnormally low energy surface of AL lipids is considered to arise from the bulky and fluid polyisoprenoid chain.

Changes in ascorbic acid content in primary cultured rat hepatocytes exposed to 2,2'-azobis (2-amidinopropane) dihydrochloride, a radical initiator

Changes in ascorbate content in primary cultured rat hepatocytes exposed to oxidative stress derived from water soluble radical initiator 2,2'-azobis (2-amidinopropane) dihydrochloride (AAPH) were examined. Cells were exposed to 0.05 and 5 mg/ml of AAPH as 'mild' and severe' oxidative stresses, respectively. Lipid peroxidation in hepatocytes was induced by 'severe' oxidative stress, but not by 'mild' oxidative stress. Ascorbate decreased at 6 hr after administration of both mild' and severe' oxidative stresses, and recovered to the control level after a further 6 hr. In cells treated with 'severe oxidative stress, however, total ascorbate (reduced form plus oxidized form) had increased 24 hr after administration. These results indicated that consumption alone did not account for the increase of ascorbate in hepatocytes under oxidative stress.

[A case of neurofibromatosis 2 combined with a vagal neurilemmoma in the mediastinum]

A 39-year-old man was referred to our hospital for further evaluation of an abnormal mediastinal shadow on chest X-ray film. CT scan of the chest showed a cyst-like tumor in the mediastinum. CT scan of the brain to investigate the impairment of hearing revealed bilateral cerebropontine angle tumors. Histological examination of both tumors revealed neurilemmoma. Neurofibromatosis 2 combined with a vagal neurilemmoma in the mediastinum is very rare.

Lasting increase in D1 dopamine receptors in the lateral part of the substantia nigra pars reticulata after subchronic methamphetamine administration

To examine the possible involvement of D1 dopamine receptors in behavioral sensitization induced by subchronic methamphetamine (MAP) administration, regional D1 receptors labeled with [3H]SCH 23390 were examined using binding assay and quantitative autoradiography. Rats received 4 mg/kg/day MAP (i.p.) for 14 days, and were decapitated after an abstinence period of 24 h, 7 days or 21 days. In MAP-treated rats, a significant decrease in Kd in the mesolimbic area was observed 24 h but not 7 days after the last injection. Neither Kd nor Bmax changed in the striatum or medial prefrontal cortex of MAP-treated rats after any period of abstinence. Autoradiography revealed a significant increase in specific [3H]SCH 22390 binding in the lateral part of the substantia nigra pars reticulata (SNr) of MAP-treated rats. Since this increase lasted up to 21 days after cessation of subchronic MAP administration, it is suggested that lasting increase in the nigral D1 receptors may be associated with the biological changes underlying MAP-induced behavioral sensitization.

Effects of selective D-1 and D-2 dopamine antagonists on development of methamphetamine-induced behavioral sensitization

The present study examined effects of selective antagonists of D-1 and D-2 dopamine receptors on the development of behavioral sensitization produced by repeated methamphetamine (MAP) administration. Male Sprague-Dawley rats were divided into four groups. Each group received a daily injection of saline (control group), 4 mg/kg MAP (MAP group), 1 mg/kg YM-09151-2 plus 4 mg/kg MAP (YM + MAP group) or 0.5 mg/kg SCH 23390 plus 4 mg/kg MAP (SCH + MAP group) for 14 days. During daily injection for 14 days, the MAP group exhibited a progressive augmentation in locomotor and stereotyped behavior, whereas the progression of such behaviors in the YM + MAP and SCH + MAP group was completely prevented. After an abstinence period of 7 days, all groups received a challenge of 2 mg/kg MAP. The MAP challenge reproduced hyperlocomotion and intense stereotyped behavior only in the MAP group. However, neither the YM + MAP group nor the SCH + MAP group showed stereotypy. The manner in which both groups showed only hyperlocomotion was similar to that observed in the control group. These results indicate that both selective D-1 antagonists and selective D-2 antagonists not only reverse MAP-induced motor effects at each injection but also prevent the development of behavioral sensitization induced by repeated MAP administration.

[Maternal beta-endorphin secretion during pregnancy--measurement of immunoreactive beta-endorphin in urine]

Gestational variations in maternal beta-endorphin (beta-end) secretion were investigated by simultaneous measurements of plasma and urinary immunoreactive beta-endorphin (ir-beta-end). Urinary ir-beta-end was extracted by using a Sep-Pak C18 column and was found to be stable for at least 24 hours at room temperature. Plasma and urine (2 hour collection) samples were obtained from 41 pregnant women and 7 non-pregnant women. Almost parallel increases in plasma and urinary ir-beta-end were observed during the course of pregnancy and there was a good correlation between them. Compared with non-pregnant values, significant increases (p less than 0.001) were observed after 36 weeks of gestation. We also studied chromatographic patterns of urinary extracts of non-pregnant and pregnant women. Both of them consist of 4 peaks and resemble each other. They were essentially similar to those of plasma extracts except for the third peak which appeared between the elution position of beta-lipotropin (beta-LPH) and beta-end. In conclusion, maternal beta-end secretions increase in late gestation not only in plasma but also in urine.

Hypothalamic function of secondary anovulatory women

In order to investigate the hypothalamic function of the women suffering from ovulatory defect, serial determinations of the serum gonadotropins (LH and FSH) were made over a period of 120 hrs following the intramuscular injection of estradiol benzoate (E.B.) 1 mg. Ten normal cycling women and 57 anovulatory women, excluding premature ovarian failure, were subjected to this study. The positive release of LH in serum (exceeds at least 150% of basal level) to E. B. were noted in follicular phase of the normal cycles, but not in luteal phase, and in 31 of 57 anovulatory women the release occurred between 48 to 96 hrs after the E.B. injection. The LH surge after EB. was difficult to provoke when the basal serum LH and estradiol (E2) levels were low as less than 10 mIU/ml and 50 pg/ml, respectively. Thirteen of 27 women, who showed LH surge, ovulated by Clomid. Only 3 of 17 women, who did not show LH surge to E.B., ovulated as a response to Clomid. Ten of 14 cases, who showed LH surge to E.B. but not ovulated by Clomid, revealed polycystic ovarian disease (PCO), and the responsiveness to E.B. and Clomid improved after wedge-resection of the ovaries. These results suggest that the serum E2 level is closely correlated with the ability for LH-RH production in hypothalamic "surge center" either primarily or secondarily, and that E.B. provocation test is useful to investigate the hypothalamic function of anovulatory patients and to preoperatively diagnose the PCO patients refractory to Clomid treatment.

Detection of subclinical abortion in infertile women by beta-hCG radioimmunoassay

Serum hCG was measured by specific beta-hCG radioimmunoassay during the late luteal phase in 58 infertile women recording the basal body temperature. As control, serum hCG was also measured during the 5th to 17th day after the basal body temperature shift in 18 normal pregnancy. In all normal pregnancy cases serum hCG was detected after the 9th day from basal temperature shift. Serum hCG was detected during the late luteal phase in 6 cases, including 2 cases succeeded in pregnancy in corresponding cycle, out of 58 infertile women. In spite of the hCG detection, the hyperthermic phase on BBT chart was not significantly prolonged in remaining 4 cases, in which the next menses took place as usual. Thus, so called subclinical abortion was suspected in these 4 cycles. This result suggests subclinical abortion might occur in infertile women. When hCG is detected during the late luteal phase, intensive treatment for the defective luteal function may salvage the endangered pregnancy. Since the incidence of hCG detection in this study was rather smaller than the previous reports, the major portion of causes of infertility might exist earlier or around the time of implantation of fertilized ovum.

[A simple method for estimating the day of ovulation by basal body temperature chart (author's transl)]

A new method for estimating the day of ovulation was assessed. The method is as follows; The range of hypothermic phase presumed 0.1 degrees C around mean basal body temperature of early 10 menstrual days. The day of ovulation was estimated by searching for the day which is followed by at least 4 consecutive days of rising temperature within the range of hypothermic phase. The accuracy of this method was assessed by comparing the basal body temperature and urinary luteinizing hormone (LH) peak day. The estimated day fell within 2 days during which the ovulation will occur most probably in 36 cycles (69%) and fell within 4 days around most expectable ovulation time in 46 cycles (88%). This result provide some insight into the limitation of the basal body temperature which is influenced by factors other than progesterone in determining the time of ovulation. But our simple objective method is useful in some cases than any other method determined by vague criteria.