Adcitmer® , a new CD56-targeting monomethyl auristatin E-conjugated antibody, is a potential therapeutic approach in Merkel cell carcinoma

BACKGROUND

Merkel cell carcinoma (MCC) is an aggressive skin cancer, whose tumour cells often express CD56. While immune checkpoint inhibitors constitute a major advance for treating patients with MCC with advanced disease, new therapeutic options are still urgently required.

OBJECTIVES

To produce and evaluate the therapeutic performance of a new antibody-drug conjugate (Adcitmer^® ) targeting CD56 in preclinical models of MCC.

METHODS

CD56 expression was evaluated in a MCC cohort (immunohistochemistry on a tissue microarray of 90 tumour samples) and MCC cell lines. Interaction of an unconjugated CD56-targeting antibody with CD56⁺ MCC cell lines was investigated by immunohistochemistry and imaging flow cytometry. Adcitmer^® product was generated by the bioconjugation of CD56-targeting antibody to a cytotoxic drug (monomethyl auristatin E) using the McSAF Inside^® bioconjugation process. The chemical properties and homogeneity of Adcitmer^® were characterized by hydrophobic interaction chromatography. Adcitmer^® cytotoxicity was evaluated in vitro and in an MCC xenograft mice model.

RESULTS

Similar to previous reports, CD56 was expressed by 66% of MCC tumours in our cohort, confirming its relevance as a therapeutic target. Specific binding and internalization of the unconjugated CD56-targeting antibody was validated in MCC cell lines. The high homogeneity of the newly generated Adcitmer^® was confirmed by hydrophobic interaction chromatography. The CD56-mediated cytotoxicity of Adcitmer^® was demonstrated in vitro in MCC cell lines. Moreover, Adcitmer^® significantly reduced tumour growth in a MCC mouse model.

CONCLUSIONS

Our study suggests that Adcitmer^® should be further assessed as a therapeutic option in patients with MCC, as an alternative therapy or combined with immune checkpoint inhibitors.

Identifying radon priority areas and dwellings with radon exceedances in Bulgaria using stored CD/DVDs

The implementation of the 2013/59/EURATOM directive in the part related to radon exposure imposes challenges for radon measurement methodology and radon survey design. Among them is the need to have estimates (preferably direct) of the annual average radon concentrations, which can be directly compared to the recommended reference levels. On this basis, the surveys should make possible the identification of dwellings with indoor radon above the reference levels and "radon priority areas" where significant proportion of the dwellings falls in this category. The performance of the CD/DVD method for radon measurements as a tool to address these issues is presented. A recent large scale field study based on the CD/DVD method that was carried out in the suburb area of Sofia, Bulgaria is described. Part of the studied area was affected in the past by the uranium mining and milling industry. In total 462 disks (CDs and DVDs) taken from 335 private dwellings from 10 districts in the region were analyzed. The results revealed the large heterogeneity in radon distribution in the area, with the percentage of dwellings with a ²²²Rn level above 300 Bq m^-3 ranking from about 7% to 74%. The district of Yana, for which this percent was 74, was identified as the area of highest radon priority in the region. The paper also discusses how prompt identification of dwellings with radon above the reference level by CD/DVDs can be incorporated within an integrated approach to the radon problem. Within this approach the radon hazard is identified shortly after the stakeholder's decision to test, which allows fast solution of the problem without waiting the long (and usually demotivating) one-year period needed for direct results by the commonly used prospective methods.

THE CD/DVD METHOD AS A TOOL FOR THE HEALTH PHYSICS SERVICE AND VENTILATION DIAGNOSTICS IN UNDERGROUND MINES

The CD/DVDs used as radon (222Rn) and thoron (220Rn) detectors can provide a sufficiently sensitive and cost-efficient option for passive radiation monitoring in underground mines. This note presents results of measurements made under real environmental conditions by CD/DVDs. Comparison with conventional diffusion chambers was made and good correspondence was observed. Correlation between 222Rn and 220Rn was studied by CD/DVDs and no signs for any correlation were observed. Dedicated study in a mine gallery showed that CD/DVDs can be successfully used for the purposes of ventilation diagnostics by identifying sources of air contaminated with radon.

Homologs of the rolC gene of naturally transgenic toadflaxes Linaria vulgaris and Linaria creticola are expressed in vitro

Agrobacterium mediated transformation is the most common way for obtaining transgenic plants in laboratory conditions. At the same time, there are species inside the genera Nicotiana, Linaria and Ipomoea that contain homologs of agrobacterial T-DNA genes as a result of genetic transformation of their ancestral forms in natural conditions. Such plants are called naturally transgenic plants, and T-DNA in their genomes is called cellular (cT-DNA). It is proposed that in the evolution of these genera, the introduced sequences played an important role. This idea is confirmed by the data on the expression of some T-DNA genes in Nicotiana and Ipomoea. Until the last moment, the expression of cT-DNA genes in Linaria has not been documented. However, the analysis of the nucleotide sequence indicates the functionality of rolC gene in L. vulgaris Mill., L. acutiloba Fisch. ex Rchb., L. genistifolia (L.) Mill. In this research work, we have sequenced the rolC homolog in one more toadflax species (Linaria creticola Kuprian). The in silico analysis of this gene has shown that it can encode a full-length peptide. Using the real time RT-PCR method, we have demonstrated that the rolC homolog is expressed in vitro in shoots, roots and calli of L. vulgaris Mill., as well as in shoots of L. creticola Kuprian. The results obtained are an important argument in favor of the fact that cT-DNA is functional and that its fixation in genomes played a certain role in the evolutionary process. However, the level of expression of the gene studied is quite low. A similar trend was observed in other naturally transgenic species. This can explain the absence of explicit morphological differences of species containing cT-DNA from their non-transgenic relatives.

COMPARATIVE STUDY OF RADON AND THORON MEASUREMENTS IN FOUR ROMANIAN SHOW CAVES

Measurements have been carried out using four types of passive detectors in four of the most popular show caves in Romania. Three types of detectors (RSKS, RadTrak and CD) were used for radon measurements and two (Raduet and CD) for thoron measurement. Activity concentrations in air were measured in the same locations for two seasons, autumn and winter. Measured values for the different caves varied between below detection limit (5 Bq m-3) and 4024 Bq m-3 for radon and from below 10 to 583 Bq m-3 for thoron. The results indicate a very good correlation between RSKS and RadTrak detectors (r = 0.96). The most significant difference between radon concentrations measured with different types of detectors (RSKS and CD) was higher than 150%. The study suggests that the activity concentration of radon in caves, measured using track detectors, could not be influenced by the type of detector used if the microclimate factor is acknowledged.

Mixed haemosporidian infections are associated with higher fearfulness in Yellow Wagtail (Motacilla flava)

Blood parasite infections have been shown to influence behavioural traits of their avian hosts, in particular activity level and boldness. Following the hypothesis that a mixed infection by different parasite species should have higher effects than single-species infections, we analysed activity and boldness in wild-caught Yellow Wagtails (Motacilla flava L., 1758), a trans-Saharan migrant, during the energetically demanding spring migration. Eighty-five percent of the birds were naturally infected with Haemoproteus Kruse, 1890 or Plasmodium Marchiafava and Celli, 1885 (Sporozoa, Haemosporida) and 27% of individuals had parasites from both genera. No differences in activity were found among uninfected, single infection, and mixed infection groups. Birds with infections from both genera appeared to be more fearful when first introduced to a cage. These birds also tended to be less likely to approach a novel object compared with uninfected birds and birds infected by a single genus only.

Host preferences of ornithophilic biting midges of the genus Culicoides in the Eastern Balkans

Many biting midges of the genus Culicoides Latreille, 1809 (Diptera: Ceratopogonidae) are competent vectors of a diverse number of pathogens. The identification of their feeding behaviour and of vector-host associations is essential for understanding their transmission capacity. By applying two different nested polymerase chain reaction (PCR) assays, of which one targeted the avian cyt b gene and the other targeted the COI gene of a wide range of vertebrates, we identified the blood hosts of six biting midge species including Culicoides circumscriptus, Culicoides festivipennis, Culicoides punctatus, Culicoides pictipennis, Culicoides alazanicus and Culicoides cf. griseidorsum, the latter two of which are reported in Bulgaria for the first time. Bird DNA was found in 50.6% of 95 investigated bloodmeals, whereas mammalian DNA was identified in 13.7%. Two Culicoides species were found to feed on both birds and mammals. There was remarkable diversity in the range of avian hosts: 23 species from four orders were identified in the abdomens of four Culicoides species. The most common bird species identified was the magpie, Pica pica (n = 7), which was registered in all four ornithophilic biting midge species. Six bloodmeals from the great tit, Parus major, were recorded only in C. alazanicus. None of the studied species of Culicoides appeared to be restricted to a single avian host.

Genetically encoded fluorescent sensors of membrane potential

Imaging activity of neurons in intact brain tissue was conceived several decades ago and, after many years of development, voltage-sensitive dyes now offer the highest spatial and temporal resolution for imaging neuronal functions in the living brain. Further progress in this field is expected from the emergent development of genetically encoded fluorescent sensors of membrane potential. These fluorescent protein (FP) voltage sensors overcome the drawbacks of organic voltage sensitive dyes such as non-specificity of cell staining and the low accessibility of the dye to some cell types. In a transgenic animal, a genetically encoded sensor could in principle be expressed specifically in any cell type and would have the advantage of staining only the cell population determined by the specificity of the promoter used to drive expression. Here we critically review the current status of these developments.

Subdermal laterocranial mapping of sentinel lymph nodes in breast cancer as an alternative to the peritumoral mapping

PURPOSE

Peritumoral injection of blue dye is standard method of sentinel lymph nodes (SLN) biopsy in breast cancer. Applying the marker to different locations will be of great benefit in cases in which the peritumoral mapping is difficult to implement. The aim of this study was to demonstrate that the subdermal laterocranial (SLC) mapping with a dye has similar diagnostic reliability to the peritumoral mapping and is applicable for clinical use.

PATIENTS AND METHODS

254 patients with operable breast cancer (cT<or=(3 cm)N0M0) underwent SLN mapping. SLC mapping was carried out in 150 patients, and classic peritumoral mapping in 95. In the cases with SLC mapping the dye was injected subdermally in the laterocranial part of the breast, 2-3 cm mediocaudally from the macroscopic contour of the gland. In this location the dye was injected into 3 points. The rest of the procedure followed the protocol for mapping with the standard peritumoral method.

RESULTS

SLC mapping was successful in 145 (97%) of the cases. In 54 (37%) patients the SLN were positive and in 91 (63%) negative. In 2 patients false-negative results were taken. Standard peritumoral mapping was successful in 94 (99%) cases. The SLN were positive in 35 (37%) patients and negative in 59 (63%). False-negative result was seen in 1 patient. Both methods of SLN mapping gave almost identical results.

CONCLUSION

The laterocranial and peritumoral method of SLN mapping are equal with regard to their diagnostic reliability. The results suggest that the laterocranial method can be used in clinical practice.

Homo obesus: a metabotrophin-deficient species. Pharmacology and nutrition insight

In most countries the prevalence of obesity now exceeds 15%, the figure used by the World Health Organization to define the critical threshold for intervention in nutritional epidemics. Here we describe Homo obesus (man the obese) as a recent phenotypic expression of Homo sapiens. Specifically, we classified Homo obesus as a species deficient of metabotrophic factors (metabotrophins), including endogenous proteins, which play essential role in the maintenance of glucose, lipid, energy and vascular homeostasis, and also improve metabolism-related processes such as inflammation and wound healing. Here we propose that pharmaceuticals, nutraceuticals and xenohormetics targeting transcriptional, secretory and/or signaling pathways of metabotrophins, particularly adiponectin, nerve growth factor, brain-derived neurotrophic factor, interleukin-10, and sirtuins, might be new tools for therapy of Homo obesus. Brief comment is also given to (i) exogenous metabotrophic agents represented by various classes of drugs, and (ii) adiponutrigenomics of lifespan.

[Efficiency and safety of the intravenous application of esomeprazole (nexium - Astra Zeneca) in high risk patients subjected to mechanic ventilation]

INTRODUCTION

The aim of the research was to determine the effectivity and the safety of the intravenous application of Esomeprazole (Nexium - Astra Zeneca) like prevention of the development of stress-ulcers of the gastric mucous with high risk patients at ICU with mechanic ventilation.

PATIENTS AND METHODS

47 patients subjected to mechanic ventilation over 48 hours with availability of just one more risk factor for development of stress-ulcers of gastric musous were included in the study. Samples of gastric juice for determination of the acidity and presence of fresh erythrocytes and microbiological cultures from gastric contents, wash away of the mouth cavity and tracheal aspiration were tested on the 1st, the 3rd and the 5th day from the start of the treatment. At the end of the therapy there has been determinated the outcome - survivor or died and total quantity of the haemotransfusions.

RESULTS

The acidity of the gastric juice changed in the range over pH 5 during the 24 hours by the application of esomeprazole. Fibrogastroscopic examinations were performed of patients who were found to have fresh erythrocytes in the gastric contents. No one was registered with bleeding of the gastric mucous. The isolated microorganisms of the gastric juice and wash away of mouth cavity were identical with those of tracheobronchial aspiration in about 13 %.

CONCLUSIONS

In our study the application of esomeprazole i.v. was effective and safe approach for profilaxy of the stress-ulcers and the bleeding of the gastric mucous. Comparative studies with H2-blockers and sucralfat are necessary for clarifying and objectifying the significance of the microbiologic isolates of the gastric contents and wash away from mouth cavity and their relation to the development of nosocomial pneumonia.

[Endoscopic treatment of pelvic inflamatory disease]

The authors present their own attempt of miniinvasive management of pelvic inflammatory disease. Two groups of patients are compared--in the first one the women are treated only conservatively, while the second one has undergone miniinvasive surgical treatment. The preferences of combined therapy are pointed out.

[Pathologic handling and investigation of surgical resected specimen in rectal cancer]

A methodic for pathologic handling and investigation of surgical resection specimen in rectal cancer is presented. It is conformed with recent trends of multidisciplinary approach to rectal cancer. Surgeon is involved in macroscopic investigation of the fresh specimen, whether pathologist is responsible for macroscopic and histological examination of the fixed specimen. A model of clinicomorphologic reporting chart for rectal cancer is developed. Special attention is given to inspection for completeness of the "mesorectum" and rectal fascia, as well as investigation of circumferential resection margin. Precise and exact handling and investigation of resected specimen from rectal cancer patients improve the accuracy of the staging, serve valuable information for radicality and quality of the performed operation, and determine the appropriate adjuvant therapy.

Hepatoprotective effect of isonicotinoylhydrazone SH7 against chronic isoniazid toxicity

This study was carried out to investigate whether 3,5-dichloro-salicylaldehyde isonicotinoyl hydrazone (SH7), an analogue of the antituberculosis drug isoniazid (INH), recently synthesized in our laboratory, could prevent isoniazid-induced liver damage. Forty-two white healthy mice were treated, once daily for 30 days, with solutions of INH, SH7 and combinations of them at doses of 7.5 mg/kg p.o. and 15 mg/kg p.o. At the end of this period, livers were harvested for histopathological analysis. The levels of lipid peroxidation products (MDA) and the activities of antioxidant defense enzymes, superoxide dismutase (SOD) and catalase (CAT), were also measured in the liver homogenates. Treatments with combinations of INH and SH7 decreased the levels of MDA, normalized the previously depressed levels of SOD and CAT and prevented isoniazid-induced liver damages. A previously demonstrated tuberculostatic and superoxide scavenger activity (SSA) of the isonicotinoylhydrazone SH7 and results from the present study thus set out a proposal for a new isoniazid/SH7 combination therapy designed to provide hepatoprotection.

Treatment of patients with bacterial infections of the central nervous system--a pharmaco-economical analysis

The meningitis and the meningoencefalitis is 29% from all of the organic diseases of the Central Nerve System. The actuality of this problem is determined by the following factors: 1. Social-only the childish group and the active group of workers among the adults are concerned; 2. The diseases are taking their course seriously with a high percentage of lethality-30%; 3. When there is untimely and inadequate therapy, there occurred additional manifestations of the disease.

Pharmaco-economical analysis of the treatment with antibiotics in a surgery department

6-Oxo-4(2-thienyl)-2-thioxo-1,3-dihydropyrimidine-5-carbonitrile (1) was synthesized and reacted with alkyl halides to give the S-alkyl compounds (2a,b), which reacted with phosphorous oxychloride to yield (3a,b). Reaction of 3a,b with phenyl-hydrazine, hydrazine hydrate, ammonia, acid hydrazides and thiourea leads to formation of the compounds (4a,b), the dihydrazino compound derivative (5), the amino compounds (7a,b), triazolopyrimidine derivatives (9a-d), and the mercapto compounds (10a,b), respectively. Treatment of (10a) with chloroacetone gave (11a), which condensed with benzaldehyde giving the tricyclic compound (12). Also (10b) reacted with ethyl chloroacetate followed by hydrolysis and cyclization yielded (14). Heating of (5) gave (6), which reacted with sodium nitrite and/or carbondisulphide and give (15) and (16), respectively.

Analysis of the expenses for drugs in the stationary departments of the united regional hospitals

The rate of the health expenses is an important factor for the fulfillment of the actions in the field of the healthcare. The means, collected from different financial sources/the National budget-98% from the necessary means, receipts out of the budget-1.5%, collected means from the population-0.5%/are spent as it follows: for the National health institutions of the municipalities-65%; for the health institutions of national level and for the central supply with some kind of drugs, serums and vaccines-17%; for the health institutions, financed directly from the International Fond-18% from the means. The main part from the means are spent for salaries and for the social security of the staff.

Information needs of young scientific workers and pre-graduated students in the sphere of pharmacy

The development of the Pharmaceutical science and its information insurance in the conditions of a transition period attain greater importance. The increase of the stream of information is more and more difficult for processing and from there-for usage.

Pharmaco-economical analysis of the treatment with antibiotics in a surgery department

The fulfillment of a pharmaco-economical analysis of the treatment with antibiotics is an important task in the conditions of a transition period, that is currently in Bulgaria. The great problem with the insufficient financial sources prevents the supply with drugs, medical supply and technology. This analysis is a kind of an auxiliary source in the process of managing in the sphere of the health policy and in particular--in the sphere of the pharmacy.

Analysis of the drugs, applied for the treatment of the patients, hospitalized in a urological department, by pharmacological groups

The analysis of the drugs, applied for the treatment of the hospitalized patients in a urological department shows that the application of the drugs in a urological department gives the opportunity to stop the process of the development of the disease and to avoid the hospitalization of the patients. The research shows the different pharmacological groups of drugs that are applied and also the expenses that are made for the treatment of the patients.

Analysis of the expenses for drugs in the stationary departments of the united regional hospitals

This issue is an attempt for estimation of the expenses for drugs in a stationary departments of the united regional hospitals in Sofia. We applied variation, unparametric, alternative methods. The results from this issue will improve the health care in Bulgaria and will provide the introduction of the new healthcare reform.

[Lipoma of the temporal lobe]

This is a case report on a 16-year-old girl presenting lipoma located in the temporal cerebral lobe, in conjunction with an ever increasing frequency of epileptic seizures, unresponsive to the anticonvulsive treatment carried out. A comprehensive analysis is done of the data concerning clinical course, diagnostic examinations' specificity and microsurgical removal of the lipoma with ensuing optimal postoperative results--total abatement of epileptic seizures against the background of reduced anticonvulsive therapy throughout the 3.5 years observation period. The literature survey shows that intracranial lipomas with the location described represent as casuistic rarity.

Cancer incidence in Republic of Bulgaria aircrew, 1964-1994

BACKGROUND

This study includes all cases of cancer among Republic of Bulgaria Air Force and civil aviation aircrew. Cancer incidence, Standardized Incidence Ratios (SIRs) and 95% confidential intervals were calculated for the pilots, using data about cancer incidence in the same age groups of the male population of the Republic of Bulgaria for the same period of time, taken from the National Cancer Register.

RESULTS

The results show a considerable difference in the structure of cancer among males in Bulgaria, as compared to male pilots (r<0.0001). While cancer of the respiratory system has the greatest incidence among the civil population, cancer of the bladder has the greatest incidence among pilots, followed by testicular and skin cancer. For the period under consideration there is a lower risk of malignant diseases in pilots as compared to the rest of the population. There is a higher risk of testicular cancer only in civil aviation pilots. For Air Force aircrew there is a 10-fold higher risk of bladder cancer as compared to the rest of the population.

CONCLUSION

We established an interdependence between age and cancer incidence, cancer incidence being higher among pilots in the age group from 20-40 yr. For the remaining age groups, cancer incidence among the civil population is approximately 2.5 times higher. Of the pilots with cancer, 73.53% returned to a flying career after an average of 7 mo treatment.

Rapid telomere shortening in children

Telomere shortening may reflect the total number of divisions experienced by a somatic cell and is associated with replicative senescence. We found that the average rate of telomere shortening in peripheral blood mononuclear cells (PBMCs) obtained longitudinally from nine different infants during the first 3 years of life (270 bp per year) is more than fourfold higher than in adults and does not correlate with telomerase activity. These results show that the rate of telomere loss changes during ontogeny, suggesting the existence of periods of accelerated cell division. Because human immunodeficiency virus (HIV) preferentially infects actively dividing cells, our observation suggesting accelerated cell division in children may provide an explanation for some of the distinctive pathogenic features of the HIV disease in infants, including higher viral loads and more rapid progression to acquired immunodeficiency syndrome (AIDS).

Human immunodeficiency virus type 1 neutralizing antibodies accelerate clearance of cell-free virions from blood plasma

The concentration of human immunodeficiency virus type 1 (HIV-1) particles in blood plasma is very predictive of the subsequent disease course in an infected individual; its measurement has become one of the most important parameters for monitoring clinical status. Steady-state virus levels in plasma reflect a balance between the rates of virions entering and leaving the peripheral blood. We analyzed the rate of virus clearance in the general circulation in rhesus macaques receiving a continuous infusion of cell-free particles in the presence and absence of virus-specific antibodies. Here we show, by measuring virion RNA, particle-associated p24 Gag protein and virus infectivity, that the clearance of physical and infectious particles from a primary, dual-tropic virus isolate, HIV-1DH12, is very rapid in naive animals, with half-lives ranging from 13 to 26 minutes. In the presence of high-titer HIV-1DH12-specific neutralizing antibodies, the half-life of virion RNA was considerably reduced (to 3.9-7.2 minutes), and infectious virus in the blood became undetectable. Although physical virus particles were eliminated extravascularly, the loss of virus infectivity in the blood reflected the combined effects of extravascular clearance and intravascular inactivation of HIV-1 infectivity due to antibody binding.

HIV infection: how effective is drug combination treatment?

The rate of decline of plasma HIV RNA in patients treated with anti-retroviral drugs has been postulated to reflect the half-lives of previously HIV-infected cells. Here, Zvi Grossman and colleagues argue that the observed decline is explained by the kinetics of ongoing infection cycles. Residual cell-to-cell infection that becomes increasingly difficult to block could stabilize cellular provirus reservoirs.

A computed tomography method for studying the degree of postoperative aeration of maxillary sinuses

Most patients with chronic odontogenic sinusitis experience aeration problems which remain unresolved even after classic radical antrotomy has been performed. The aim of this study was to create a high-yield diagnostically feasible and accurate CT technique which would allow the evaluation of the degree of postoperative changes of maxillary sinus aeration and overcome the limited value of traditional imaging modalities. We studied the aeration sequelae in the maxillary sinus following antrotomy in thirty-five patients employing Sytec 3000 CT scan equipment with modern densoprofile software. We found a prevalence of 62.92% for minor complications following antrotomy--a reduction in the volume of the maxillary sinus up to 25%, whereas the more serious complications accounted for 5.72%. Conventional radiologic modalities demonstrated only 25% of these changes. Our results underscore the importance of the densoprofile CT technique as a valuable and accurate diagnostic tool in detecting the changes consistent with the postantrotomy syndrome.