METH-1, a human ortholog of ADAMTS-1, and METH-2 are members of a new family of proteins with angio-inhibitory activity

We have studied two related proteins that contain a repeated amino acid motif homologous to the anti-angiogenic type 1 repeats of thrombospondin-1 (TSP1). Complete sequence analysis revealed no other similarities with TSP1, but identified unique signal sequences, as well as metalloprotease and disintegrin-like domains in the NH(2) termini. We named these proteins METH-1 and METH-2 due to the novel combination of metalloprotease and thrombospondin domains. Overall amino acid sequence identity between METH-1 and METH-2 is 51. 7%, yet transcript distribution revealed non-overlapping patterns of expression in tissues and cultured cell lines. To characterize these proteins functionally, we isolated full-length cDNAs, produced recombinant protein, and generated antisera to the recombinant proteins. Both METH-1 and METH-2 represent single copy genes, which encode secreted and proteolytically processed proteins. METH proteins suppressed fibroblast growth factor-2-induced vascularization in the cornea pocket assay and inhibited vascular endothelial growth factor-induced angiogenesis in the chorioallantoic membrane assay. Suppression of vessel growth in both assays was considerably greater than that mediated by either thrombospondin-1 or endostatin on a molar basis. Consistent with an endothelial specific response, METH-1 and METH-2 were shown to inhibit endothelial cell proliferation, but not fibroblast or smooth muscle growth. We propose that METH-1 and METH-2 represent a new family of proteins with metalloprotease, disintegrin, and thrombospondin domains. The distinct distribution of each gene product suggests that each has evolved distinct regulatory mechanisms that potentially allow for fine control of activity during distinct physiological and pathological states.

Plasma ctDNA RAS mutation analysis for the diagnosis and treatment monitoring of metastatic colorectal cancer patients

Background

RAS assessment is mandatory for therapy decision in metastatic colorectal cancer (mCRC) patients. This determination is based on tumor tissue, however, genotyping of circulating tumor (ct)DNA offers clear advantages as a minimally invasive method that represents tumor heterogeneity. Our study aims to evaluate the use of ctDNA as an alternative for determining baseline RAS status and subsequent monitoring of RAS mutations during therapy as a component of routine clinical practice.

Patients and methods

RAS mutational status in plasma was evaluated in mCRC patients by OncoBEAM™ RAS CRC assay. Concordance of results in plasma and tissue was retrospectively evaluated. RAS mutations were also prospectively monitored in longitudinal plasma samples from selected patients.

Results

Analysis of RAS in tissue and plasma samples from 115 mCRC patients showed a 93% overall agreement. Plasma/tissue RAS discrepancies were mainly explained by spatial and temporal tumor heterogeneity. Analysis of clinico-pathological features showed that the site of metastasis (i.e. peritoneal, lung), the histology of the tumor (i.e. mucinous) and administration of treatment previous to blood collection negatively impacted the detection of RAS in ctDNA. In patients with baseline mutant RAS tumors treated with chemotherapy/antiangiogenic, longitudinal analysis of RAS ctDNA mirrored response to treatment, being an early predictor of response. In patients RAS wt, longitudinal monitoring of RAS ctDNA revealed that OncoBEAM was useful to detect emergence of RAS mutations during anti-EGFR treatment.

Conclusion

The high overall agreement in RAS mutational assessment between plasma and tissue supports blood-based testing with OncoBEAM™ as a viable alternative for genotyping RAS of mCRC patients in routine clinical practice. Our study describes practical clinico-pathological specifications to optimize RAS ctDNA determination. Moreover, OncoBEAM™ is useful to monitor RAS in patients undergoing systemic therapy to detect resistance and evaluate the efficacy of particular treatments.

Adherence of human vaginal lactobacilli to vaginal epithelial cells and interaction with uropathogens

Three strains of Lactobacillus, identified as Lactobacillus acidophilus, Lactobacillus gasseri, and Lactobacillus jensenii, were selected from among 70 isolates from the vaginas of healthy premenopausal women for properties relevant to mucosal colonization or antagonism. All three self-aggregated and adhered to epithelial vaginal cells, displacing well-known vaginal pathogens, such as G. vaginalis, and inhibiting the growth in vitro of Escherichia coli and Streptococcus agalactiae. The surface components involved in self-aggregation appeared to be proteins for L. gasseri and lipoproteins for L. acidophilus and L. jensenii, as judged by susceptibility to treatment with appropriate degrading enzymes. The factors responsible for adherence to epithelial vaginal cells seemed to be glycoproteins (L. acidophilus and L. gasseri) and carbohydrate (L. jensenii). The receptors of the vaginal cells were glycolipids, which presumably were the targets of the competition observed between the lactobacilli and the pathogenic microbes.

Bioremediation of diesel-contaminated soils: evaluation of potential in situ techniques by study of bacterial degradation

The development of a simple laboratory methodology allows the implementation of in situ bioremediation of polluted soils with diesel fuel. In this investigation microbiological and chemical analyses and a suitable bioreactor design, were very useful for suggesting the best ways to improve biodegradation extents in a diesel-enriched soil. Biostimulation with inorganic nitrogen and phosphorus produced the best results in a simple bioreactor, with biodegradation extents higher than 90% after 45 days. Also, the addition of activated sludge from a domestic wastewater plant increased the degradation rate to a great extent. In both cases, microbiological studies showed the presence of Acinetobacter sp. degrading most of the hydrocarbons. Simultaneously, a diesel fuel release (approximately 400,000 l) was studied. Samples taken in polluted soil and water revealed that bacteria from the genus Acinetobacter were predominant. In plate studies, Acinetobacter colonies produced a whitish substance with the characteristics of a biosurfactant. Remarkably, the presence of this product was evident at the field site, both in the riverbanks and in the physical recovery plant. The study of the similarities between laboratory results and the diesel spill site strongly suggested that natural conditions at the field site allowed the implementation of in situ bioremediation after physical removal of LNAPL (light nonaqueous-phase liquids).

Progesterone regulates proliferation of endothelial cells

The use of steroid hormones in postmenopausal replacement therapy has been associated with prevention of cardiovascular disease. Although the contribution of estradiol to endothelial cell function has been addressed, little information is available on the effect of progestins on this cell type. Here, we provide direct evidence for the presence of functional nuclear progesterone receptor in endothelial cells and demonstrate that physiological levels of progesterone inhibit proliferation through a nuclear receptor-mediated mechanism. The effects of progesterone were blocked by pretreatment with a progesterone receptor antagonist, and progesterone receptor-deficient endothelial cells failed to respond to the hormone. We evaluated the effect of progesterone by analysis of aorta re-endothelialization experiments in wild-type and progesterone receptor knockout mice. The rate of re-endothelialization was significantly decreased in wild-type mice when in the presence of progesterone, whereas there was no difference between control and progesterone-treated progesterone receptor knockout mice. FACS analysis showed that progestins arrest endothelial cell cycle in G1. The lag in cell cycle progression involved reduction in cyclin-dependent kinase activity, as shown by down-regulation in retinoblastoma protein phosphorylation. In addition, treatment of endothelial cells with progestins altered the expression of cyclin E and A in accordance with G1 arrest. These results have important implications to our current knowledge of the effect of steroids on endothelial cell function and to the overall contribution of progesterone to vascular repair.

In vitro and in vivo induction of brown adipocyte uncoupling protein (thermogenin) by retinoic acid

The effects of retinoic acid (RA) isomers (all-trans-RA and 9-cis-RA) on the appearance of uncoupling protein (UCP; thermogenin), the only unequivocal molecular marker of the brown adipocyte differentiated phenotype, have been investigated in primary cultures of brown adipocytes, in the brown adipocyte cell line HIB 1B and directly in intact mice. The results obtained with cultured cells indicate that retinoids function as inducers of the appearance of UCP and, at the same time, partially inhibit brown adipocyte cell proliferation. The two RA isomers displayed similar effectiveness as UCP inducers, their effect being comparable with that triggered by noradrenaline, so far considered to be the main modulator of UCP gene expression. The effectiveness of retinoids as UCP inducers was dependent on the stage of brown adipocyte differentiation, being maximal in confluent primary cells and in the medium-late differentiation stage of HIB 1B cells. Corroborating the results obtained in vitro, we show that administration of all-trans-RA or 9-cis-RA to mice leads to an increase in their brown adipose tissue specific UCP content. 9-cis-RA treatment also prevented the loss of UCP on cold deacclimation. To our knowledge, this is the first report of a stimulatory effect of retinoid compounds on UCP induction in vivo.

Bacteremia due to Staphylococcus epidermidis: microbiologic, epidemiologic, clinical, and prognostic features

Staphylococcus epidermidis was established as the causal agent of true bacteremia on the basis of microbiologic, epidemiologic, clinical, and prognostic data on 65 episodes of S. epidermidis bacteremia (SEB) recorded in the Hospital Covadonga of Oviedo, Spain, during 1982-1986. All isolates were susceptible in vitro to vancomycin, mercury, silver, cadmium, and malachite green, and 95.2% of isolates were susceptible to cephalothin; a dominant biotype, four resistotypes (ion-dye resistance patterns), and four antibiotypes (antibiotic resistance patterns) were found. A high percentage of isolates (76.7%) produced slime, and several potentially toxic exoproteins were detected in various and generally lower proportions. The main clinical features of SEB were high frequency in male patients greater than 40 years of age, fever, leukocytosis, anemia, and phlebitis. Indwelling devices were the most common portal of entry. The overall death rate was 36.9%. Underlying disease, hemodynamic status, predisposing factors, and treatment were statistically significant parameters in relation to mortality.

The Fagerström Test for Nicotine Dependence in a Spanish sample

The Fagerström Test for Nicotine Dependence was developed to improve the reliability and validity of the Fagerström Tolerance Questionnaire. In this study, we examined the applicability of the Spanish version of such test as well as its relationship to sex, age, and consumption of cigarettes, in a representative sample of smokers from Galicia, Spain (N = 646).

High-precision measurement of the W boson mass with the CDF II detector

The mass of the W boson, a mediator of the weak force between elementary particles, is tightly constrained by the symmetries of the standard model of particle physics. The Higgs boson was the last missing component of the model. After observation of the Higgs boson, a measurement of the W boson mass provides a stringent test of the model. We measure the W boson mass, M_W, using data corresponding to 8.8 inverse femtobarns of integrated luminosity collected in proton-antiproton collisions at a 1.96 tera-electron volt center-of-mass energy with the CDF II detector at the Fermilab Tevatron collider. A sample of approximately 4 million W boson candidates is used to obtain [Formula: see text], the precision of which exceeds that of all previous measurements combined (stat, statistical uncertainty; syst, systematic uncertainty; MeV, mega-electron volts; c, speed of light in a vacuum). This measurement is in significant tension with the standard model expectation.

Changes of the basement membrane and type IV collagen in human skin during aging

OBJECTIVES

To determine the relationship between skin collagen IV and basement membrane changes during aging, a total of 35 women who had been admitted for surgery, were studied.

METHODS

Subjects were arranged into six age-groups (from 35 to 60 years). Skin biopsies were performed in all patients and the samples were taken from a site 6 cm above the pubic symphysis. The collagen IV content and the epithelial basement membrane were analyzed by using immunohistochemical, transmission electron microscopy and computer-assisted image analysis methods. The skin collagen IV content was measured by an image analysis program and expressed in arbitrary units of integrate optical density, and, the basement membrane thickness was expressed in nanometers.

RESULTS

Type IV collagen content decreased with age after 35 years (r = -0.9561). The epithelial basement membrane thickness increased significantly with age (r = 0.98192; P < 0.01) and there is an inverse correlation between these two parameters (r = -0.990502).

CONCLUSIONS

Although type IV collagen is a basement membrane component and declines with aging, the total thickness of this membrane increases, which suggests a reduction in tissue turnover.

Functional analysis of pneumolysin by use of monoclonal antibodies

We have produced a panel of monoclonal antibodies to pneumolysin, the membrane-damaging toxin from Streptococcus pneumoniae. We have used these antibodies to identify three regions of the toxin sequence that are involved in the lytic mechanism of this toxin. Two of these sites probably form the cell binding site of this toxin. Antibodies to the third site inhibit the lytic action of this toxin but not the binding of this toxin to cells. This site is engaged in the oligomerization process involved in the formation of pores in cell membranes. Two of these epitopes are also present in the related toxin perfringolysin O.

Protection against pneumococcal pneumonia in mice by monoclonal antibodies to pneumolysin

Pneumolysin (PLY) is an important virulence factor of Streptococcus pneumoniae. We examined the ability of three murine monoclonal antibodies (MAbs) to PLY (PLY-4, PLY-5, and PLY-7) to affect the course of pneumococcal pneumonia in mice. The intravenous administration of antibodies PLY-4 and PLY-7 protected the mice from the lethal effect of the purified toxin. Mice treated with PLY-4 before intranasal inoculation of S. pneumoniae type 2 survived longer (median survival time, 100 h) than did untreated animals (median survival time, 60 h) (P < 0.0001). The median survival time for mice treated with a combination of PLY-4 and PLY-7 was 130 h, significantly longer than that for mice given isotype-matched indifferent MAbs (P = 0.0288) or nontreated mice (P = 0.0002). The median survival time for mice treated with a combination of three MAbs was significantly longer (>480 h) than that for mice treated with PLY-5 (48 h; P < 0.0001), PLY-7 (78 h; P = 0.0007), or PLY-4 (100 h; P = 0.0443) alone. Similarly, the survival rate for mice treated with three MAbs (10 of 20 mice) was significantly higher than the survival rate obtained with PLY-5 (1 of 20; P = 0.0033), PLY-4 (2 of 20; P = 0.0138), or PLY-7 (3 of 20; P = 0.0407) alone. These results suggest that anti-PLY MAbs act with a synergistic effect. Furthermore, MAb administration was associated with a significant decrease in bacterial lung colonization and lower frequencies of bacteremia and tissue injury with respect to the results for the control groups.

An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations

To adapt the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations, a Spanish translation of the scale was interviewer-administered to 554 subjects aged 18-34 years (65.9% women) and the ratings so obtained were compared with the SCID-CV-based diagnoses of expert clinicians. The internal consistency of the scale was satisfactory (Cronbach's alpha=0.89). Four factors identified by exploratory factor analysis (Depressive/Somatic, Positive Affect, Retarded Activity and Interpersonal Relations) accounted for 55.9% of the variance. A score of 26 was identified as a suitable cut-off for screening purposes, affording a sensitivity of 0.906 and a specificity of 0.918.

The role of pneumolysin in mediating lung damage in a lethal pneumococcal pneumonia murine model

Background

Intranasal inoculation of Streptococcus pneumoniae D39 serotype 2 causes fatal pneumonia in mice. The cytotoxic and inflammatory properties of pneumolysin (PLY) have been implicated in the pathogenesis of pneumococcal pneumonia.

Methods

To examine the role of PLY in this experimental model we performed ELISA assays for PLY quantification. The distribution patterns of PLY and apoptosis were established by immunohistochemical detection of PLY, caspase-9 activity and TUNEL assay on tissue sections from mice lungs at various times, and the results were quantified with image analysis. Inflammatory and apoptotic cells were also quantified on lung tissue sections from antibody treated mice.

Results

In bronchoalveolar lavages (BAL), total PLY was found at sublytic concentrations which were located in alveolar macrophages and leukocytes. The bronchoalveolar epithelium was PLY-positive, while the vascular endothelium was not PLY reactive. The pattern and extension of cellular apoptosis was similar. Anti-PLY antibody treatment decreased the lung damage and the number of apoptotic and inflammatory cells in lung tissues.

Conclusion

The data strongly suggest that in vivo lung injury could be due to the pro-apoptotic and pro-inflammatory activity of PLY, rather than its cytotoxic activity. PLY at sublytic concentrations induces lethal inflammation in lung tissues and is involved in host cell apoptosis, whose effects are important to pathogen survival.

Relationship between mutations in the gyrA gene and quinolone resistance in clinical isolates of Corynebacterium striatum and Corynebacterium amycolatum

Quinolone susceptibility was analyzed in 17 clinical isolates of Corynebacterium striatum and 9 strains of Corynebacterium amycolatum by the E-test method in Mueller-Hinton agar plates. The C. striatum ATCC 6940 strain was used as a control strain. The amplified quinolone resistance determining regions of the gyrA genes of C. amycolatum and C. striatum were characterized. Four in vitro quinolone-resistant mutants of C. amycolatum were selected and analyzed. Both in vivo and in vitro quinolone-resistant strains of C. amycolatum showed high levels of fluoroquinolone resistance in strains with a double mutation leading to an amino acid change in positions 87 and 91 or positions 87 and 88 (unusual mutation) of GyrA, whereas the same concomitant mutations at amino acid positions 87 and 91 in GyrA of C. striatum produced high levels of resistance to ciprofloxacin and levofloxacin but only showed a moderate increase in the MIC of moxifloxacin, suggesting that other mechanism(s) of quinolone resistance could be involved in moxifloxacin resistance in C. amycolatum. Moreover, a PCR-RFLP-NcoI of the gyrA gene was developed to distinguish between C. amycolatum and C. striatum species.

Epidemiological study of Streptococcus pneumoniae carriers in healthy primary-school children

To obtain information on the Streptococcus pneumoniae carrier state in Spanish children, 332 healthy 6-year-old children from nine primary schools in northern Spain were screened. Thirty-six percent of the children had positive cultures yielding 128 strains. Seventy-one strains belonged to 14 serogroup/serotypes, the most frequent being 19, 23, 3, 24 and 11. Fifty-seven strains were nontypeable. The identification of strains with equivocal results was confirmed at species level by means of hybridisation with a specific probe, pneumolysin-mediated agglutination and a pathogenicity test in mice. Sixty-four percent of strains showed resistance to penicillin, 22% of these also being resistant to cefotaxime. More than 40% of the strains were resistant to trimethoprim-sulfamethoxazole, tetracycline and erythromycin. Twenty percent of the erythromycin-resistant strains were susceptible to clindamycin. Two strains were resistant to rifampicin and one strain was resistant to ofloxacin. All strains were susceptible to vancomycin. Previous antibiotic administration and having siblings under the age of 2 years correlated with the carriage of pneumococcus. There was no correlation with the carriage of antibiotic-resistant strains, or a record of previous infections, previous hospital admissions or having relatives with chronic respiratory disease.

The conserved undecapeptide shared by thiol-activated cytolysins is involved in membrane binding

Thiol-activated cytolysins share a conserved hydrophobic, Trp-rich undecapeptide that is suggested to be involved in membrane binding and intercalation. The neutralizing monoclonal antibody PLY-5 recognizes all members of this toxin family and peptide mapping assigned its epitope to the undecapeptide motif. This antibody inhibited binding of the toxins to host cell membranes and the epitope was no longer available for binding when a preformed toxin/membrane complex was tested. These results confirm the model of cytolysin binding suggested by structural data.

Comparison of relaxation training with a cognitive-behavioural intervention for indicated prevention of depression in university students: a randomized controlled trial

Although cognitive-behavioural programmes for preventing depression have produced promising findings, their administration requires extensive training. Relaxation techniques are more straightforward psychological strategies, but they have not been investigated in the prevention of depression. This trial aimed to compare the results of relaxation training (RT) with that of a cognitive-behavioural programme (CBT) for prevention of depression in university students with elevated depressive symptoms. The 133 participants (mean age 23.3 years, 82% women) were randomly assigned to CBT or RT. Both programmes were administered to groups of 5 or 6 participants in eight weekly 90-min sessions. Participants were evaluated by independent raters before, immediately after, and 3 and 6 months after taking part in the programmes. By itself, intervention type had no significant effect on either depression or anxiety scores. The scores were lower at the follow-up time points with respect to pre-intervention scores. Effect size was greatest between pre- and immediately post-intervention scores for CBT, d = 1.32, 95% CI [1.00, 1.64], and between pre- and 6-month post-intervention scores for RT, d = 0.75, 95% CI [0.47, 1.03]. Anxiety symptoms were significantly improved by both interventions at 3-month follow-up, and by CBT at 6-month follow-up also. In the medium term (3-6 months), relaxation training produced similar reductions in depressive and anxiety symptoms as a more complex cognitive-behavioural programme.

Spanish validation of the 10-item Connor-Davidson Resilience Scale (CD-RISC 10) with non-professional caregivers

OBJECTIVES

Despite the importance of resilience in populations under stress, and the fact that the 10-item version Connor-Davidson Resilience Scale (CD-RISC 10) is the shortest instrument for reliable and valid evaluation of resilience, there are no data on their psychometric properties in non-professional caregivers. The aim of this study was to analyze the psychometric properties and factorial structure of the spanish version of the CD-RISC 10 in non-professional caregivers.

METHOD

Independently trained assessors evaluated resilience, self-esteem, social support, emotional distress and depression in a sample of 294 caregivers (89.8% women, mean age 55.3 years).

RESULTS

The internal consistency of CD-RISC 10 was α = .86. A single factor was found that accounted for 44.7% of the total variance. Confirmatory factor analysis corroborated this unifactorial model. The CD-RISC 10 was significantly correlated with the self-esteem (r = .416, p < .001) and social support (r = .228, p < .001) scales, and the emotional distress scale (r = -.311, p < .001), though this was an inverse relationship. A score ≤ 23 was a suitable cut-off point for discriminating caregivers with depression (sensitivity = 70.0%, specificity = 68.2%).

CONCLUSION

The CD-RISC 10 is a reliable and valid instrument to evaluate resilience in the caregiver population.

Serogroups of Escherichia coli isolated from piglets in Spain

Serogroups of 1334 E. coli colonies isolated in Spain between 1986 and 1991 from piglets with diarrhoea, oedema disease and from healthy piglets, were determined. The serogroups determined in E. coli from diarrhoea were: O1, O2, O4, O5, O7, O8, O9, O12, O20, O21, O23, O25, O26, O32, O39, O45, O54, O75, O78, O80, O83, O91, O92, O101, O103, O113, O115, O116, O118, O125, O127, O138, O139, O141, O149, O153 and O157; from pigs with oedema disease: O8, O101, O138, O149 and O157; and from healthy piglets: O1, O2, O5, O7, O8, O9, O20, O21, O26, O29, O45, O64, O71, O80, O81, O91, O101, O105, O113, O115, O116, O126, O128, O132, O138, O139, O142, O146, O149, O152, O153, and O168. Serogroups O138, O141 and O149 were found to be statistically associated with enteric porcine colibacillosis (diarrhoea and oedema disease) (0.025 > P < 0.01). In addition, enterotoxigenic (ETEC) strains belonged to serogroups: O8, O9, O20, O101, O138, O141 and O149; verotoxigenic (VTEC) strains (VTEC) strains to serogroups 091 and 0138; and necrotizing (NTEC) strains to serogroups O2, O4, O8, O54, O78 and O83. Furthermore, 91.2% (249 out 273) of the ETEC (LT and/or STa) and/or VTEC strains belonged to only seven different serogroups. These major serogroups to which the ETEC and VTEC strains belonged, were determined in a lower percentage (21.2%) among non-toxigenic E. coli colonies isolated from sick and healthy piglets.

Characterization of indigenous vaginal lactobacilli from healthy women as probiotic candidates

The probiotic relevant characteristics of 45 strains of vaginal Lactobacillus isolated from healthy women were analyzed. Of these, 21 strains were classified as L. crispatus, 17 as L. jensenii, six as L. gasseri, and one as L. plantarum. The rate of acidification varied significantly between the strains as did their ability to form biofilms. None used glycogen as a fermentable carbohydrate. H2O2 generation was common, especially among L. jensenii isolates (88%). No bacteriocinogenic strains were detected. Most strains harbored plasmids (from 1 to 7) of various sizes, those in excess of 50 kb being frequent. One of these plasmids was found to be promiscuous since it hybridized with extrachromosomal bands of 15 isolates. All strains were resistant to metronidazole, ciprofloxacin, gentamicin, clindamycin, trimethoprim, and sulfametoxazole and susceptible to a series of beta-lactams, erythromycin, tetracycline, and benzalkonium chloride. Almost half of the strains were highly resistant to nonoxinol 9, which is commonly used as a spermicide. Based on these analyses, strains of all three common species are proposed as new probiotic candidates.

Evidence for a particle produced in association with weak bosons and decaying to a bottom-antibottom quark pair in higgs boson searches at the tevatron

We combine searches by the CDF and D0 Collaborations for the associated production of a Higgs boson with a W or Z boson and subsequent decay of the Higgs boson to a bottom-antibottom quark pair. The data, originating from Fermilab Tevatron pp collisions at √s = 1.96 TeV, correspond to integrated luminosities of up to 9.7 fb(-1). The searches are conducted for a Higgs boson with mass in the range 100-150 GeV/c(2). We observe an excess of events in the data compared with the background predictions, which is most significant in the mass range between 120 and 135 GeV/c(2). The largest local significance is 3.3 standard deviations, corresponding to a global significance of 3.1 standard deviations. We interpret this as evidence for the presence of a new particle consistent with the standard model Higgs boson, which is produced in association with a weak vector boson and decays to a bottom-antibottom quark pair.

Effectiveness and safety of perampanel as early add-on treatment in patients with epilepsy and focal seizures in the routine clinical practice: Spain prospective study (PERADON)

OBJECTIVE

Perampanel (PER) has been shown to be effective as an adjunctive therapy for controlling refractory focal-onset seizures (FOS). However, the information as early add-on for the treatment of FOS in the clinical practice is still scarce and must be further assessed.

METHODS

An observational prospective study was conducted to evaluate the effectiveness of early add-on PER, assessed as 50% responders (seizure frequency reduced by at least 50% during the last 3 months as compared with baseline) rate at 6 and 12 months, in patients with FOS in the routine clinical practice of Spain.

RESULTS

One hundred and thirteen patients (mean age: 40.3 years, 51.3% male) with FOS received PER as early add-on (1st add-on: 37.2% and 2nd: 62.8%) for a mean exposure of 11 months (mean PER dose: 6.3 mg/day at month 12). At 6 months, 50.4% and 20.4% of the patients were responders and seizure-free (respectively) relative to baseline (3 months prior to PER initiation), and at 12 months, 68.1% and 26.5% of the patients were responders and seizure-free (respectively), relative to baseline (3 months prior to PER initiation). The retention rate at 6 and 12 months was 83.2% and 80.5%, respectively. The percentage of seizure-free patients at 12 months was significantly (p = 0.033) higher when PER was added as first vs. second add-on. The number of concomitant antiepileptic drugs (AEDs) was significantly reduced from baseline to 6 and 12 months (p = 0.001). Treatment was simplified in 23.9% of patients at the end of the observation period. Drug-related adverse events (AEs), most mild or moderate, were reported in 30.1% of patients, with irritability (8%) and dizziness (7.1%) as the most frequent ones.

CONCLUSIONS

This is the first observational, prospective study to evaluate efficacy and safety of early adjunctive treatment with PER in patients with focal epilepsy at 12 months. Perampanel demonstrated a good efficacy and safety profile when used at a median dose of 6 mg/day, regardless of the combination with other AEDs. Adverse events were mild or moderate, with dizziness being the most frequent one.