High interindividual variability in LDL-cholesterol reductions after inclisiran administration in a real-world multicenter setting in Germany

BACKGROUND AND AIMS

Low-density lipoprotein cholesterol (LDL-C) is the main therapeutic target in the treatment of hypercholesterolemia. Small interfering RNA (siRNA) inclisiran is a new drug, which targets PCSK9 mRNA in the liver, reducing concentrations of circulating LDL-C. In randomized trials, inclisiran demonstrated a substantial reduction in LDL-C. The German Inclisiran Network (GIN) aims to evaluate LDL-C reductions in a real-world cohort of patients treated with inclisiran in Germany.

METHODS

Patients who received inclisiran in 14 lipid clinics in Germany for elevated LDL-C levels between February 2021 and July 2022 were included in this analysis. We described baseline characteristics, individual LDL-C changes (%) and side effects in 153 patients 3 months (n = 153) and 9 months (n = 79) after inclisiran administration.

RESULTS

Since all patients were referred to specialized lipid clinics, only one-third were on statin therapy due to statin intolerance. The median LDL-C reduction was 35.5% at 3 months and 26.5% at 9 months. In patients previously treated with PCSK9 antibody (PCSK9-mAb), LDL-C reductions were less effective than in PCSK9-mAb-naïve patients (23.6% vs. 41.1% at 3 months). Concomitant statin treatment was associated with more effective LDL-C lowering. There was a high interindividual variability in LDL-C changes from baseline. Altogether, inclisiran was well-tolerated, and side effects were rare (5.9%).

CONCLUSION

In this real-world patient population referred to German lipid clinics for elevated LDL-C levels, inclisiran demonstrated a high interindividual variability in LDL-C reductions. Further research is warranted to elucidate reasons for the interindividual variability in drug efficacy.

Chromosome number and ploidy level of balm (Melissa officinalis)

Background

Lemon balm (Melissa officinalis L.) is of increasing importance resulting in rising growth area. Improved knowledge on the genome structure, number of chromosomes in connection with the taxonomical structure of balm is indispensable for improved new varieties.

Results

A collection of 40 balm accessions (M. officinalis) was characterized by flow cytometry and FISH (18/25S and 5S rDNA) to determine the chromosome number and ploidy level. Three different types were found: diploid genotypes with 2n = 2× = 32 chromosomes; tetraploid 2n = 4× = 64 chromosomes and triploid 2n = 3× = 48 chromosomes. A haploid base number of × = 16 chromosomes is likely. First time described triploid accessions are sterile but cytologically and morphologically stable for many years. Triploids express better winter hardiness and regeneration after harvesting cuts as well as bigger leaves and internodes.

Conclusions

A basic chromosome number of x = 16 is reported for the first time for the species M. officinalis.

Formation of onion bulblets in vitro and viability during medium-term storage

 The influences of light conditions, sucrose and ethylene on in vitro formation and storability of onion (Allium cepa L.) bulblets were studied in various accessions. Light, sucrose and ethylene influenced bulb formation. Storability was primarily enhanced by a high sucrose concentration (100 g/l) in the culture medium. The bulbing process was characterised by changes in bulbing ratio, leaf length, number of leaves and leaf development time. The viability of bulbs after 1 year of in vitro storage at low temperatures was determined by their growth reaction in subsequent subcultures, growth after transfer into the greenhouse and tetrazolium staining. Sufficient sprouting of bulblets previously stored at -1  °C demonstrated the possibility of storing them in a low-temperature, slow-growth culture.

Interactions between Quaternary Ammonium Surfactant Oligomers and Water-Soluble Modified Guars

The interaction between hydroxypropylguar (HPG) and its dodecyl-modified derivative (HMHPG) and cationic surfactant oligomers has been investigated by measurements of the solution viscosity at constant shear rate, microviscosity of the aggregates (dipyrenylpropane fluorescence emission spectra), and aggregation number of the polymer hydrophobe and of the surfactant (time-resolved fluorescence quenching). The surfactants are dodecyltrimethylammonium bromide (DTAB, monomeric surfactant) and some of its dimers and trimers which differed by the carbon number s of the polymethylene spacer connecting the surfactant moieties (2 </= s </= 20). Most results refer to a polymer concentration of 1 wt%. Only a weak interaction was evidenced between HPG and these surfactants, whereas strong interactions occurred between HMHPG and the surfactant oligomers. The interaction became stronger as the degree of oligomerization of the surfactant increased. The results led us to distinguish three ranges of concentration of added surfactant. The first range corresponds to surfactant concentrations below the surfactant cmc in water. In this range mixed aggregation occurs between polymer hydrophobes and surfactant ions, and the viscosity of the HMHPG + surfactant systems goes through a maximum, as usually found for associating polymers. The second range extends from the cmc to about 10 cmc. Precipitation of a polymer/surfactant complex occurs in this range with all surfactants forming threadlike micelles. For the other surfactants the viscosity goes through a minimum. In the third range, which corresponds to surfactant concentrations above 10 cmc, resolubilization of the precipitated HMHPG/surfactant complexes occurs and a solution-to-gel transition is observed for the surfactants which form threadlike micelles or vesicles. The concentration corresponding to this transition is about the same as that for pure surfactant solutions. Some polymer hydrophobes may contribute to the formation of additional bridges between surfactant micelles. Copyright 1999 Academic Press.