Diagnosis and Management of Suspected Pediatric Autoimmune Encephalitis: A Comprehensive, Multidisciplinary Approach and Review of Literature

Autoimmune encephalitis is an increasingly recognized entity in children. When treated promptly, favorable outcomes are seen in a majority of pediatric patients. However, recognition of autoimmune encephalitis in young patients is challenging. Once autoimmune encephalitis is suspected, additional difficulties exist regarding timing of treatment initiation and duration of treatment, as evidence to guide management of these patients is emerging. Here, we review available literature regarding pediatric autoimmune encephalitis and present our institution's comprehensive approach to the evaluation and management of the disease. These guidelines were developed through an iterative process involving both pediatric neurologists and rheumatologists.

Open-Label Phase 3 Study of Intravenous Golimumab in Patients With Polyarticular Juvenile Idiopathic Arthritis

Objectives

To assess efficacy, pharmacokinetics (PK) and safety of intravenous (i.v.) golimumab in patients with polyarticular-course JIA (pc-JIA).

Methods

Children aged 2 to <18 years with active pc-JIA despite MTX therapy for ≥2 months received 80 mg/m² golimumab at weeks 0, 4, then every 8 weeks through week 52 plus MTX weekly through week 28. The primary and major secondary endpoints were PK exposure and model-predicted steady-state area under the curve (AUC_ss) over an 8-week dosing interval at weeks 28 and 52, respectively. JIA ACR response and safety were also assessed.

Results

In total, 127 children were treated with i.v. golimumab. JIA ACR 30, 50, 70, and 90 response rates were 84%, 80%, 70% and 47%, respectively, at week 28 and were maintained through week 52. Golimumab serum concentrations and AUC_ss were 0.40 µg/ml and 399 µg ⋅ day/ml at week 28. PK exposure was maintained at week 52. Steady-state trough golimumab concentrations and AUC_ss were consistent across age categories and comparable to i.v. golimumab dosed 2 mg/kg in adults with rheumatoid arthritis. Golimumab antibodies and neutralizing antibodies were detected via a highly sensitive drug-tolerant assay in 31% (39/125) and 19% (24/125) of patients, respectively. Median trough golimumab concentration was lower in antibody-positive vs antibody-negative patients. Serious infections were reported in 6% of patients, including one death due to septic shock.

Conclusion

Body surface area-based dosing of i.v. golimumab was well tolerated and provided adequate PK exposure for clinical efficacy in paediatric patients with active pc-JIA.

ClinicalTrials.gov number NCT02277444

The experimental determination of Th(iv)/Th(iii) redox potentials in organometallic thorium complexes

The first Th^IV/Th^III redox couple values have been determined experimentally using cyclic voltammetry (CV), which has been facilitated by the use of [ⁿBu₄N][BPh₄] as a supporting electrolyte in THF. Th(iv) and Th(iii) metallocene compounds have been studied and their redox couple values are in the range of -2.96 V to -3.32 V vs FeCp₂^+/0.

Concomitant Carboxylate and Oxalate Formation From the Activation of CO2 by a Thorium(III) Complex

Improving our comprehension of diverse CO₂ activation pathways is of vital importance for the widespread future utilization of this abundant greenhouse gas. CO₂ activation by uranium(III) complexes is now relatively well understood, with oxo/carbonate formation predominating as CO₂ is readily reduced to CO, but isolated thorium(III) CO₂ activation is unprecedented. We show that the thorium(III) complex, [Th(Cp′′)₃] (1, Cp′′={C₅H₃(SiMe₃)₂‐1,3}), reacts with CO₂ to give the mixed oxalate‐carboxylate thorium(IV) complex [{Th(Cp′′)₂[κ²‐O₂C{C₅H₃‐3,3′‐(SiMe₃)₂}]}₂(μ‐κ²:κ²‐C₂O₄)] (3). The concomitant formation of oxalate and carboxylate is unique for CO₂ activation, as in previous examples either reduction or insertion is favored to yield a single product. Therefore, thorium(III) CO₂ activation can differ from better understood uranium(III) chemistry.

Steric control of redox events in organo-uranium chemistry: synthesis and characterisation of U(v) oxo and nitrido complexes

Controlling the steric environment in U(η⁸-C₈H₆(1,4-SiR₃)₂)(η⁵-Cp*)] enables selective formation of either mononuclear U(v) or dinuclear U(iv) oxo and nitrido complexes.

The synthesis and molecular structures of a U(v) neutral terminal oxo complex and a U(v) sodium uranium nitride contact ion pair are described. The synthesis of the former is achieved by the use of ^tBuNCO as a mild oxygen transfer reagent, whilst that of the latter is via the reduction of NaN₃. Both mono-uranium complexes are stabilised by the presence of bulky silyl substituents on the ligand framework that facilitate a 2e^– oxidation of a single U(iii) centre. In contrast, when steric hindrance around the metal centre is reduced by the use of less bulky silyl groups, the products are di-uranium, U(iv) bridging oxo and (anionic) nitride complexes, resulting from 1e^– oxidations of two U(iii) centres. SQUID magnetometry supports the formal oxidation states of the reported complexes. Electrochemical studies show that the U(v) terminal oxo complex can be reduced and the [U(iv)O]^– anion was accessed via reduction with K/Hg, and structurally characterised. Both the nitride complexes display complex electrochemical behaviour but each exhibits a quasi-reversible oxidation at ca. –1.6 V vs. Fc^+/0.