POS0692 IANALUMAB (VAY736) SAFETY AND EFFICACY IN PATIENTS WITH SJOGREN’S SYNDROME: 52 WEEK RESULTS FROM A RANDOMISED, PLACEBO-CONTROLLED, PHASE 2B DOSE-RANGING TRIAL

Background:

Sjogren’s syndrome (SS) is an autoimmune disease affecting excretory glands and characterised by B-cell hyperactivity. Ianalumab (VAY736) is a human monoclonal antibody to B-cell activating factor receptor, engineered for direct ADCC-mediated B-cell depletion. A Phase 2b study evaluated the dose-response of VAY736 vs placebo (PBO) in EULAR SS Disease Activity Index (ESSDAI) change from baseline (CHB) and other secondary endpoints.

Objectives:

Primary results at Week (Wk) 24 were reported previously1. Here we report 52 Wk safety and efficacy from extended blinded treatment period 2 (TP2).

Methods:

190 patients (pts) were randomised equally to receive s.c. doses of VAY736 (5, 50, 300 mg) or PBO every 4 Wks (q4w). Eligible pts fulfilled American European Consensus Group (AECG) criteria, were anti-Ro/SSA+, had ESSDAI ≥6 and EULAR SS Patient Reported Index (ESSPRI) ≥5. At Wk 24, after completion of the first blinded TP (TP1), PBO-treated pts were switched to VAY736 150 mg, and pts on 300 mg were re-randomised to continue 300 mg or PBO for 28 Wks in TP2. Pts were followed post-treatment for ≥20 Wks. Safety was assessed for all periods. Due to lack of PBO-control in TP2, descriptive efficacy analysis was performed for ESSDAI, ESSPRI, Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F), Physician’s (PhGA) and Patient’s Global Assessments (PaGA), SF-36, and SS symptom diary (SSSD).

Results:

Overall, there was no dose dependency of treatment emergent adverse events (TEAEs) except for injection site reactions, which were mostly mild to moderate in severity. Lymphopenia and neutropenia were mostly grade (G)1 and G2, no G4. Most common TEAEs were infections and infestations in exposure-adjusted analysis of incidence rates. Nasopharyngitis and upper respiratory tract infections were the most common TEAEs, with no dose response (Table 1). Tracheobronchitis and pneumonia, were mild to moderate severity, not associated with absolute neutrophil count G3, and none led to treatment withdrawal.

At Wk 52, efficacy was sustained for pts who continued 300 mg in TP2 (ESSDAI, ESSPRI, PaGA, PhGA CHB: –9.06, –1.91, –22.03, –35.80, respectively). Efficacy was partially lost for pts switched to PBO at Wk 24 (Figure 1). Improvement was noted for PBO pts switched to 150 mg. Stimulated whole salivary flow at Wk 24 was improved for 300 mg (PBO-adjusted CHB 0.20 ml/min; P=0·037); last measurement at Wk 48 was 0.45 and 0.22 ml/min CHB in pts who continued 300 mg or PBO in TP2, respectively.

Conclusion:

Ianalumab 300 mg was well tolerated up to 52 Wks. Exploratory efficacy showed that continuous dosing of 300 mg s.c. q4w provided sustained clinical benefit. PaGA was the outcome that showed the most prominent change following switch to PBO or VAY736.

References:

[1]Dörner T, et al. [OP0302]. Ann Rheum Dis. 2020; 79 (suppl 1).

Table 1.

Key Safety Data (All Study Periods up to Week 52)*

n (%)[EAIR]15 mg24 Wks(N=47)50 mg24 Wks(N=47)150 mg28 Wks(N=47)Any 300 mg (N=47)Any AE43 (91.5)43 (91.5)44 (93.6)45 (95.7)[517.5][423.3][621.0][544.6]Any SAE3 (6.4)5 (10.6)8 (17.0)8 (17.0)[5.9][10.7][19.9][13.6]Infections and infestations (SOC)233 (70.2)31 (66.0)34 (72.3)38 (80.9)[154.1][119.2][162.0][127.7]Nasopharyngitis37 [15.5]4 [8.5] 9 [22.1]9 [16.5]Upper respiratory tract infections36 [12.8]8 [17.8]5 [11.6]8 [13.6]Bronchitis33 [6.2]3 [6.2]4 [9.5]4 [6.6]Tracheobronchitis31 [2.0]0 [0.0]0 [0.0]3 [5.0]Pneumonia31 [2.0]0 [0.0]1 [2.2]2 [3.3]Blood & Lymphatic Disorders (SOC)28 (17.0)9 (19.1)6 (12.8)9 (19.1)[18.0][20.8][14.3][16.8]Lymphopenia34 [8.4]4 [8.6]3 [6.8]2 [3.3]Neutropenia35 [10.7]1 [2.1]2 [4.5]4 [6.9]Injection site reaction34 (8.5)9 (19.1)17 (36.2)27 (57.4)

*Includes all safety data from TP1, TP2 and post-treatment follow-up; cut-off 06-Feb-2020

1EAIR, incidence rate per 100 subject years. For patient with an event, exposure time is censored at time of first event;

2Number of pts with at least one AE in SOC;

3PT, preferred term;

SOC, system organ class

Disclosure of Interests:

Thomas Dörner Consultant of: Novartis, GSK, Sanofi, Janssen, Eli Lilly, Grant/research support from: Deutsche Forschungsgemeinschaft, Simon J. Bowman Consultant of: Astrazeneca, Biogen, BMS, Celgene, Medimmune, MTPharma, Novartis, Ono, UCB, xtlbio, Robert Fox Consultant of: Novartis, Pfizer and Lilly, Xavier Mariette Consultant of: BMS, Galapagos, Gilead, Medimmune, GSK, Grant/research support from: Servier, Athena Papas Consultant of: Novartis, Grant/research support from: Novartis, Thomas Grader-Beck Consultant of: Novartis, Lilly, Grant/research support from: Abbvie, Celgene, Ben A Fisher Consultant of: Novartis, Roche, BMS and Servier, Filipe Barcelos Consultant of: Pfizer and Lilly, Salvatore De Vita Consultant of: Roche, Human Genome Science, Glaxo Smith Kline and Novartis, Hendrik Schulze-Koops Consultant of: Novartis, Robert J Moots Consultant of: Amgen, Chugai, Gilead, Lilly, Novartis, Pfizer, Roche, Grant/research support from: Amgen, Chugai, Gilead, Lilly, Novartis, Pfizer, Roche, Guido Junge Shareholder of: Novartis, Employee of: Novartis, Janice Woznicki Shareholder of: Novartis, Employee of: Novartis, Monika Sopala Shareholder of: Novartis, Employee of: Novartis, Wen-Lin Luo Shareholder of: Novartis, Employee of: Novartis, Wolfgang Hueber Shareholder of: Novartis, Employee of: Novartis

Characterizing Microbiota from Sjögren's Syndrome Patients

OBJECTIVE

To compare the oral microbiota of Sjögren's syndrome (SS) with that of healthy subjects (HS).

METHODS

Supragingival and subgingival biofilm samples were collected from the mesial-buccal tooth surfaces of SS patients (n = 57) and age- and sex-matched HS (n = 53). Unstimulated saliva and 8 oral tissue samples were taken using a buccal brush. Caries and periodontal measures were recorded. All supragingival samples and a subgroup of 24 SS and 28 HS subgingival samples, as well as 32 SS and 11 HS saliva and oral tissue samples, were analyzed for their content of 41 bacterial species using checkerboard DNA-DNA hybridization. Mean levels (×10⁵ ± SEM) and percentage of DNA probe counts of each species were determined for each sample site and averaged within subjects in the 2 clinical groups. Kruskal-Wallis tests, adjusting for multiple comparisons and cluster analysis, were used for soft tissue and microbial analysis, and the Mann-Whitney test was used to compare caries and periodontal measures.

RESULTS

Mean (×10⁵ ± SEM) total DNA probe counts in supragingival samples were significantly lower (P < 0.001) in the SS (13.3 ± .7) compared to the HS (44.1 ± 6.8) group. In supragingival samples, Veillonella parvula, Fusobacterium nucleatum ss vincenti, and Propionibacterium acnes were markedly elevated in the SS compared to the HS group in both mean (×10⁵ ± SEM) and mean (± SEM) percentage DNA probe counts (P < 0.001). In subgingival samples of SS, V. parvula was significantly different compared to HS (P < 0.05). SS was characterized by high levels of purple and low levels of orange and red complexes. Cluster analysis of oral tissues and saliva demonstrated that the mean microbial profiles for SS patients and the HS group clustered separately. Active root caries (P < 0.003) and attachment loss were significantly higher (P < 0.029) in the SS group compared to the HS group.

CONCLUSION

These findings indicate that saliva is a major controlling factor of intraoral biofilm. V. parvula may be a unique microbial biomarker for Sjögren's syndrome.

KNOWLEDGE TRANSFER STATEMENT

The microbiome characterized for Sjögren's syndrome in salivary hypofunction is shown to be under stress and reduced. Veillonella parvula can be a possible identification of a biomarker for Sjögren's syndrome.

OP0302 IANALUMAB (VAY736), A DUAL MODE OF ACTION BIOLOGIC COMBINING BAFF RECEPTOR INHIBITION WITH B CELL DEPLETION, REACHES PRIMARY ENDPOINT FOR TREATMENT OF PRIMARY SJOGREN’S SYNDROME

Background:

Primary Sjogren’s syndrome (pSS) is a multi-organ autoimmune disease mainly affecting excretory glands and characterised by B-cell hyperactivity. No approved systemic treatment is available. Ianalumab (VAY736) is an anti-B-cell activating factor (BAFF) receptor fully human monoclonal antibody, engineered for direct ADCC-mediated B-cell depletion.

Objectives:

This phase 2b study aimed at establishing a dose-response relationship over a range of VAY736 doses, using change from baseline (BL) in EULAR Sjogren’s Syndrome Disease Activity index (ESSDAI) over 24 Weeks (Wks) as primary endpoint. The study is ongoing with a second blinded treatment period up to Wk52. Here we report efficacy and safety Wk24.

Methods:

190 patients (pts) were randomised 1:1:1:1 to receive monthly s.c. doses of VAY736 (5, 50, 300mg) or placebo (PBO). Prior to 1st-dose of study treatment, pts received methylprednisolone i.v. 250mg. Eligible pts fulfilled American European Consensus Group (AECG) criteria, were anti-Ro/SSA+, had ESSDAI ≥6 and EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI) ≥5. Statistical methods included MCP-Mod to assess dose-response on change of ESSDAI from BL and responder rate analysis to calculate the proportion of pts with ≥3 points improvement on ESSDAI. Secondary endpoints included ESSPRI, Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F), Physician’s (PhGA) and Patient’s Global Assessments (PaGA), SF-36, stimulated salivary flow (sSF), Schirmer’s test.

Results:

Primary endpoint was met with statistically significant dose-response for ESSDAI (Figure). The largest ESSDAI reduction was 1.92 points over PBO for VAY736 300mg at Wk24. Responder rate analysis on ESSDAI revealed for 300mg vs PBO responder rates of 42/47 (89.4%) vs 30/49 (61.2%), a difference of 28.1% (p=0.0019). No differences were seen for 5mg and 50mg vs PBO. PhGA change from BL was significantly different between 300mg and PBO (p=0.022). A numerical trend for sSF improvement for VAY736 300mg compared to PBO was notable at Wk24 (p=0.092). For secondary endpoints ESSPRI and FACIT-F, VAY736 treatment showed no benefits over PBO. PBO responses were generally high. Incidence of treatment emergent AEs was comparable across all studied groups, whereby site injection reactions were most frequent, mostly mild and showed a dose-response.

Conclusion:

Primary endpoint assessing ESSDAI was met, showing statistically significant dose-response for ianalumab with clinically important improvement for 300mg vs PBO. Preliminary safety profile of ianalumab was good.

Figure.

ESSDAI Change from Baseline over Time up to Week 24 Reveals a Statistically Significant Dose Response Relationship

Disclosure of Interests:

Thomas Dörner Grant/research support from: Janssen, Novartis, Roche, UCB, Consultant of: Abbvie, Celgene, Eli Lilly, Roche, Janssen, EMD, Speakers bureau: Eli Lilly, Roche, Samsung, Janssen, Simon J. Bowman Consultant of: Astrazeneca, Biogen, BMS, Celgene, Medimmune, MTPharma, Novartis, Ono, UCB, xtlbio, Glapagos, Speakers bureau: Novartis, Robert Fox Consultant of: Novartis, Pfizer and Lilly, Xavier Mariette Consultant of: BMS, Gilead, Medimmune, Novartis, Pfizer, Servier, UCB, Athena Papas Grant/research support from: Novartis, Consultant of: Novartis, Thomas Grader-Beck Grant/research support from: Abbvie, Celgene, Consultant of: Novartis, Lilly, Ben A Fisher Consultant of: Novartis, Roche, BMS and Servier, Filipe Barcelos Consultant of: Pfizer and Lilly, Salvatore De Vita Consultant of: Roche, Human Genome Science, Glaxo Smith Kline and Novartis, Hendrik Schulze-Koops Grant/research support from: Pfizer Inc, Robert J Moots: None declared, Guido Junge Shareholder of: Novartis, Employee of: Novartis, Janice Woznicki Shareholder of: Novartis, Employee of: Novartis, Monika Sopala Shareholder of: Novartis, Employee of: Novartis, Wen-Lin Luo Shareholder of: Novartis, Employee of: Novartis, Wolfgang Hueber Shareholder of: Novartis, Employee of: Novartis

Comparison of microbial changes in early redeveloping biofilms on natural teeth and dentures

BACKGROUND

Surfaces and fluids can affect oral bacterial colonization. The aim of this study is to compare redeveloping biofilms on natural teeth and dentures.

METHODS

Supragingival plaque samples were taken from 55 dentate individuals and the denture teeth of 62 edentulous individuals before and after professional cleaning. Also, samples from seven "teeth" (samples included dentures) in randomly selected quadrants were collected after 1, 2, 4, and 7 days of no oral hygiene. Samples were analyzed using checkerboard DNA-DNA hybridization. Counts and proportions of 41 bacterial taxa were determined at each time point, and significant differences were determined using the Mann-Whitney U test. Ecological succession was determined using a modified moving window analysis.

RESULTS

Mean total DNA probe counts were similar precleaning but were higher in dentate individuals at all post-cleaning visits (P <0.01). Precleaning edentate biofilms had higher counts and proportions of Streptococcus mitis, Streptococcus oralis, and Streptococcus mutans, whereas dentate individuals had higher proportions of Tannerella forsythia, Selenomonas noxia, and Neisseria mucosa. By day 2, mean counts of all taxa were higher in natural teeth, and most remained higher at day 7 (P <0.01). Succession was more rapid and complex in dentate individuals. Both groups demonstrated increased proportions of S. mitis and S. oralis by day 1. N. mucosa, Veillonella parvula, and Eikenella corrodens increased in both groups, but later in samples from edentate individuals.

CONCLUSIONS

"Mature" natural and denture teeth biofilms have similar total numbers of bacteria but different species proportions. Post-cleaning biofilm redevelopment is more rapid and more complex on natural teeth than on denture teeth.

Use of a continuous glucose sensor in an extracorporeal life support circuit

BACKGROUND

Standard care for infants on extracorporeal life support (ECLS) relies on intermittent measurement of blood glucose (BG); however, this can lead to significant changes in BG that go unrecognized for several hours. The present study was designed to assess performance and clinical applicability of a subcutaneous glucose sensor technology modified for use as a blood-contacting sensor within the ECLS circuit.

METHODS

Twelve children, aged 3 years or less, requiring ECLS support were studied. Three continuous glucose sensors (Medtronic MiniMed) were inserted into hubs placed in line with the ECLS circuit. Blood glucose was assessed with a laboratory analyzer (BG(LAB); Bayer Rapidlab 860) approximately every 5 h (mean 4.9 ± 3.3 h) with more frequent samples obtained with a bedside monitor (HemoCue) as needed. Sensor current (I(SIG)) was transmitted to a laptop computer and retrospectively calibrated using BGLAB. Sensor performance was assessed by mean absolute relative difference (MARD), linear regression slope and intercept, and correlation, all with BGLAB as reference.

RESULTS

The BGLAB averaged 107.6 ± 36.4 mg/dl (mean ± standard deviation) ranging from 58 to 366 mg/dl. The MARD was 11.4%, with linear regression slope (0.86 ± 0.030) and intercept (9.0 ± 3.2 mg/dl) different from 1 and 0, respectively (p < .05), and correlation (r² = 0.76; p < .001). The system was not associated with any adverse events, and placement and removal into the hubs was easily accomplished. Instances in which more frequent BG values were obtained using a bedside HemoCue (BGHEMO) monitor showed the sensor to respond rapidly to changes.

CONCLUSIONS

We conclude that continuous sensors can be adapted for use in an ECLS circuit with accuracy similar to or better than that achieved with the subcutaneous site. Continuous glucose monitoring in this population can rapidly detect changes in BG that would not otherwise be observed. Further studies will be needed to assess the benefit of continuous glucose monitoring in this population.

Plasma carotenoid levels in relation to the Mediterranean diet in Greece

In the context of the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC), we conducted a cross-sectional study to examine the effects of the intake of plant foods central in the traditional Mediterranean diet on plasma levels of alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, and lutein-zeaxanthin. Study subjects were a random sample of 45 men and 68 women, aged 30-82 years, from the Greek EPIC cohort of 27,953 volunteers. Linear regression models were fitted, with the carotenoid blood levels as dependent variables. Independent variables were selected food items, as well as body mass index, controlling for energy intake and a set of demographic factors. Body mass index was inversely associated with plasma levels of the studied carotenoids. The association was highly significant for alpha-carotene and beta-carotene, significant for lutein-zeaxanthin, and borderline significant (p approximately 0.07) for lycopene. Tomato intake was significantly positively associated with plasma lycopene, and beta-carotene. Other fruity vegetables and non-fruity vegetables were significantly positively associated, the former with alpha-carotene and the latter with both alpha- and beta-carotene plasma levels. Fruits showed a highly significant positive association with plasma beta-cryptoxanthin, as well as with beta-carotene. No association was found between the intake of olive oil or other added lipids and plasma carotenoids. We conclude that among the studied components of the Mediterranean diet, fruits and vegetables tend to increase levels of some carotenoids, but olive oil has no apparent effect.

Plasma carotenoid levels in relation to tobacco smoking and demographic factors

Antioxidant compounds have been reported to play a beneficial role in the etiology of several chronic diseases. To examine the effects of tobacco smoking and demographic factors on the plasma levels of alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, and jointly, lutein-zeaxanthin, we have conducted a cross-sectional study in the context of the Greek segment of the European Prospective Investigation into Cancer and nutrition (EPIC). A random sample of 45 men and 68 women, aged 30-82 years, from the Greek EPIC cohort of 27953 volunteers, provided fasting blood samples and completed an interviewer-administered questionnaire on lifestyle factors. Data were analyzed using linear regression models with the studied vitamin plasma levels as dependent variables, and tobacco smoking and demographic factors as independent variables. Older persons had significantly lower alpha-carotene levels and significantly higher lutein-zeaxanthin levels, whereas females in comparison to males had significantly higher levels of alpha-carotene and perhaps beta-carotene. Tobacco smoking tended to reduce levels of all carotenoids studied and the reduction was statistically significant with respect to beta-cryptoxanthin and beta-carotene, whereas it was of borderline significance with respect to alpha-carotene.

Plasma retinol and tocopherol levels in relation to demographic, lifestyle and nutritional factors of plant origin in Greece

In the context of the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC) we have conducted a cross-sectional study to determine the effect of demographic, lifestyle and nutritional factors of plant origin on retinol, alpha-tocopherol and gamma-tocopherol. Study subjects were a random sample of forty-five men and sixty-eight women, aged 30-82 years, from the Greek EPIC cohort of 27953 volunteers. Analyses were done using linear regression models with the vitamin blood levels as dependent variables, and BMI, the intake of selected food items, total energy intake and a set of demographic factors as independent variables. Women had significantly lower plasma retinol levels (P<0.006) than men. Both alpha- and gamma-tocopherol levels increased by approximately 5 % for every additional 5 years of age. Among dietary factors, intake of non-fruity vegetables was associated with increase, while intake of added lipids other than olive oil with decrease, of plasma retinol levels. BMI was positively associated with plasma gamma-tocopherol only, while none of the foods or food groups investigated significantly affected the plasma levels of either of the two tocopherols. These findings need to be confirmed before attempts are made to use them in the context of explanatory mechanistic processes.

The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth

OBJECTIVES

This study compared a 10% chlorhexidine varnish treatment with placebo and sham treatments for preventing dental caries in adult patients with xerostomia (dry mouth).

DESIGN

The study was a multicentred, randomized, parallel group, double blind, placebo-controlled clinical trial.

SETTING

All examinations and procedures were performed at Tuft's University, Boston, MA, the University of British Columbia, Vancouver, BC or the University of Western Ontario, London, ON.

SUBJECTS

Subjects were adults with recent or current dental caries experience, high salivary levels of cariogenic microorganisms and low salivary flow rates.

RESULTS

236 subjects completed at least one post-treatment examination. There were 697 new carious lesions diagnosed, 446 (64%) located on coronal surfaces and 251 (36%) located on root surfaces. The mean attack rate was 0.23 surfaces/100 surfaces at risk. A treatment difference observed between the Active and Placebo groups was statistically significant for root caries increment (p = .02) and total caries increment (p = .03). A treatment difference observed between the Active and Sham groups was not statistically significant for coronal, root or total caries increment. Analysis of variance of treatment group differences was performed using mutans streptococci counts, salivary flow rates, age, sex, caries prevalence, medications, time to first event and early withdrawal as co-variables. These factors did not meaningfully alter the findings.

CONCLUSIONS

The difference between the 10% chlorhexidine varnish and placebo treatments is considered to be highly clinically significant for root caries increment (41% reduction) and for total caries increment (25% reduction) but only for coronal caries increment (14%).

Double blind clinical trial of a remineralizing dentifrice in the prevention of caries in a radiation therapy population

OBJECTIVES

The purpose of this study is to determine the efficacy and safety of a specially formulated remineralizing toothpaste in controlling caries in a group of high risk, head and neck radiation patients.

DESIGN

The study compares the performance of the remineralizing toothpaste with a leading conventional fluoride dentifrice using double-blind randomization. TEST PRODUCTS: The products compared both contain equivalent quantities of fluoride (1150 ppm). The remineralizing toothpaste also delivers soluble calcium and phosphate ions, the essential components of teeth.

SUBJECTS

On completion, 50 subjects who received > 50 Gy of radiation to the head and neck.

MEASUREMENTS

Examinations include coronal and root caries using the Pitts Diagnostic Criteria, salivary flow rate, plaque and gingival indices and microbiological counts over one year.

RESULTS

At this point subjects are enrolled in the study at various phases. However, the current average for the net increment per month per subject is -0.12 (+/- 1.30) for coronal caries and 0.06 (+/- 0.73) for root caries in subjects using the remineralizing toothpaste and 0.53 (+/- 1.62) for coronal caries and 0.45 (+/- 0.98) for root caries in subjects using the conventional fluoride dentifrice. Non-parametric analysis of rank scores for net root surface increments/month was statistically significant (p = 0.02), suggesting lower net root surface increment/month for the remineralizing toothpaste relative to the conventional toothpaste. No significant differences were noted on coronal surfaces.

CONCLUSIONS

The results to date indicate that the remineralizing toothpaste is significantly superior to the conventional fluoride dentifrice in preventing root caries in high risk patients.

Rumen-stable delivery systems

Ruminants have a distinct digestive system which serves a unique symbiotic relationship between the host animal and predominantly anaerobic rumen bacteria and protozoa. Rumen fermentation can be both beneficial by enabling utilization of cellulose and non-protein nitrogen and detrimental by reducing the nutritive value of some carbohydrates, high biological value proteins and by hydrogenating unsaturated lipids. In addition it can also result in the modification and inactivation of many pharmacologically active ingredients administered to the host animal via the oral route. The advances in ruminant nutrition and health demand a rumen-stable delivery system which can deliver the active ingredient post-ruminally while simultaneously meet efficacy, safety and cost criteria. In contrast to drug delivery systems for humans, the demand for low-cost has hindered the development of effective rumen-stable delivery systems. Historically, heat and chemical treatment of feed components, low solubility analogues or lipid-based formulations have been used to achieve some degree of rumen-stability, and products have been developed accordingly. Recently, a polymeric pH-dependent rumen-stable delivery system has been developed and commercialized. The rationale of this delivery system is based on the pH difference between ruminal and abomasal fluids. The delivery system is composed of a basic polymer, a hydrophobic substance and a pigment material. It can be applied as a coating to solid particles via a common encapsulation method such as air-suspension coating. In the future, the delivery system could be used to deliver micronutrients and pharmaceuticals post-ruminally to ruminant animals. A further possible application of the delivery system is that it could also be combined with other controlled delivery devices/systems in order to enhance slow release or to achieve targeted delivery needs for ruminants. This paper discusses the rumen protection and the abomasal release mechanism of the polymeric coating. It also reviews other rumen stable delivery systems and methods for evaluating their in vitro and in vivo performance.

Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: a case study

Serotonin reuptake inhibitors, such as fluoxetine, fenfluramine, and dexfenfluramine, are frequently used to treat obesity, depression, and bulimia. A common side effect of these medications is xerostomia, or dry mouth. A case study demonstrating the impact of drug-induced xerostomia on oral health and subsequent nutrition implications is presented. Rampant caries can result from a combination of xerostomia and inappropriate dietary and oral hygiene habits. Preventive dietary and dental guidelines are presented to assist nutrition and dental professionals in treating and counseling patients with xerostomia.

Directional changes in neutrophil adherence following passive resting versus active imagery

This study was designed to determine whether increases or decreases in neutrophil adherence could be achieved following a self-regulation (relaxation/imagery) intervention. Fifteen subjects were randomly assigned to one of three conditions. Two experimental groups employed imagery focussed on either increasing or decreasing neutrophil adherence. Subjects had two weeks of self-regulation practice (4 total training sessions) prior to blood drawings. A third group of control subjects had the same number of resting sessions without imagery training. All subjects had blood samples collected before and after either 30 minutes of self-regulation or resting practice for two sessions. Pulse and peripheral finger temperature measures were taken before and after the blood samples. Both experimental groups demonstrated decreases in neutrophil adherence, and the control showed a tendency toward increases in this measure. The psychophysiologic data for the control group was suggestive of a relaxation response. The experimental group that attempted to increase neutrophil adherence demonstrated psychophysiologic responses that were contrary to relaxation. We concluded that an active cognitive exercise or process is associated with decreases in neutrophil adherence irrespective of the exercise. In contrast, relaxation without an active imagery exercise was associated with increases in neutrophil adherence. The results of this study are discussed in terms of behavioral engineering of directional immune changes.

Tooth loss and skeletal bone density in healthy postmenopausal women

Associations between dental status and skeletal bone density were investigated in a group of 329 healthy postmenopausal women with normal bone density. Bone mineral density (BMD) of the lumbar spine, femoral neck and distal radius were measured by dual- or single-photon absorptiometry. Number of teeth remaining were counted and presence of complete dentures noted by a nurse practitioner. Forty-eight women (15%) wore a complete maxillary and/or mandibular denture: 22(7%) were completely edentulous and an additional 26 (8%) had one edentulous ridge. Among women without complete dentures (n = 281), significant positive linear relationships were observed between number of teeth and BMD at the spine (p < 0.05) and radius (p < 0.01), controlling for years since menopause, pack-years of smoking, education and body mass index. BMD did not differ between the groups with and without dentures. However, women who acquired dentures after the age of 40 years had significantly lower mean spinal and radial BMD than women who acquired dentures at age 40 years or earlier (at the radius, 0.584 +/- 0.015 v 0.630 +/- 0.017 g/cm2, p < 0.05; at the spine, 1.043 +/- 0.031 v 1.124 +/- 0.029 g/cm2, p = 0.05). In linear regression analysis, significant independent correlations were found among all women (n = 329) between number of teeth and age (partial r = -0.19, p < 0.001), pack-years of cigarette use (partial r = -0.23, p < 0.001) and years of education (partial r = +0.11, p < 0.05). These associations between dental status and BMD support the hypothesis that systemic bone loss may contribute to tooth loss.

Prevalence and intraoral distribution of coronal and root caries in middle-aged and older adults

This work describes the prevalence and intraoral distribution of coronal and root caries in 326 predominantly white, educated, middle-aged and older adults. Study participants were recruited from Tufts Geriatric Outreach Program, Nutritional Status Study (NSS), and the Forsyth Root Caries Study. Eighty-five percent of participants reported visiting their dentist in the last year. The median number of teeth was 21 in the 65+ age-group, and 40% of participants had coronal caries and 33% had root carious lesions. The mean coronal and root caries (DFS) was higher and the proportion of decayed surfaces to all decayed and filled surfaces (%D/DFS) was lower than in other comparable studies. A comparative analysis of intraoral distribution of coronal and root caries and their relation with age is discussed.

Nutritional support in treatment of oral carcinomas

Two young adults, one lean and one obese, with squamous cell carcinomas of the oral cavity received aggressive antitumor therapies with comprehensive nutritional support in an effort to minimize the secondary malnutrition that often accompanies cancer treatments.

Studies on the effects of rapeseed meal on thyroid status of cattle, glucosinolate and iodine content of milk and other parameters

The effects of feeding rapeseed meals (RSM) containing low (Tower) or high (Target/Turret) levels of glucosinolates on thyroid status, iodine and glucosinolate content of milk and other parameters were studied in dairy cows and young calves. RSM (Tower and Turret) fed to dairy cows at 25% of the grain mixture reduced iodine content of milk. Diets containing Tower and Turret RSM tended to reduce plasma thyroxine (T4) in cows and increase the size of thyroids in rats. Calf diets containing Target and Tower RSM resulted in increased liver and thyroid weights, but only those containing Target tended to reduce plasma T4 levels. Feed intake, weight gain, hemoglobin, blood cell volume and erythrocyte count in calves were not affected by diets containing Tower RSM, but Target RSM reduced all these parameters. In addition, diets containing Target caused more pronounced histological changes of the calves' thyroid than those containing Tower RSM. No measurable amounts of intact glucosinolates were detected in milk of cows fed RSM. Similarly the glucosinolate aglucones, isothiocyanates or vinyl oxazolidinethione, were not transferred to milk although small amounts of unsaturated nitrile (1-cyano-2-hydroxy-3-butene) and inorganic thiocyanate were detected in milk. Rats receiving milk from cows fed Turret RSM developed larger thyroid than those receiving milk from control-fed cows. Supplemental iodine (61.0 microgram/d) in the rat prevented the thyroid enlargement.

Prevention by menadione of the hepatotoxic effects in chickens fed rapeseed meal. Observations on coagulation factors and cytochrome P-450

Rapeseed meal, the residue after oil extraction, is an animal feed of great commercial interest. Some genetic strains of rapeseed yield a meal which when fed in high concentration produces hemorrhagic lesions in the liver of chickens. These lesions are reduced in incidence by the simultaneous feeding of menadione. This hepatotoxicity is accompanied by elevated levels of cytochrome P-450, delta-aminolevulinic acid synthetase, and the clotting factors V and X. The hemorrhagic lesions were associated with hepatic necrosis, and menadione was protective by mechanisms other than its effect on blood coagulation.