Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial

BACKGROUND

Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection.

OBJECTIVE

To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone.

DESIGN

Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978).

SETTING

Multinational, multicenter trial.

PARTICIPANTS

Adults hospitalized with COVID-19.

INTERVENTION

Intravenous ensovibep, 600 mg, or placebo.

MEASUREMENTS

Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90.

RESULTS

An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep).

LIMITATION

The trial was prematurely stopped because of futility, limiting power for the primary outcome.

CONCLUSION

Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified.

PRIMARY FUNDING SOURCE

National Institutes of Health.

The Influence of Mitochondria Enzyme Activity on Beef Tenderness

ObjectivesAmong all eating quality attributes, tenderness is often described as the most important factor dictating the overall acceptance of cooked beef, as well as, future decision to repeat purchase. While many intrinsic and extrinsic factors impact end-product tenderness, variation in tenderness is usually attributed to the extent of postmortem proteolysis occurring during meat aging. Evidence from the literature indicates that muscle fiber type composition is a major source of variation in the rate and extent of postmortem proteolysis. One of the major differences that distinguishes muscle fibers is the content of mitochondria. Typically, red muscle (slow-oxidative) is characterized by greater amounts of mitochondria than white muscle (fast-glycolytic). As part of the calcium buffering system, mitochondria sequester large quantities of calcium to maintain a constant cytosolic calcium level. We hypothesized that mitochondria may delay the activation of µ-calpain, the major protease responsible for postmortem proteolysis, through preventing the increase in cytosolic calcium concentration.Materials and MethodsTo test our hypothesis, beef longissimus thoracis muscle samples were collected at 30 min and 16 d postmortem. The 30 min samples were immediately snap frozen in liquid nitrogen and stored at – 80°C, while the 16 d samples were used to determine Warner-Bratzler shear force (WBSF) values. Based on WBSF values, the samples were allocated into less tender (average WBSF = 5.3 kg; n = 8) or more tender (average WBSF = 2.3 kg; n = 8) categories. Succinate dehydrogenase (SDH) abundance, citrate synthase (CS) activity, phosphofructokinase (PFK) activity, and glycogen phosphorylase (GP) activity were compared between the two categories using the 30 min samples. Collected data were analyzed using a Student’s t test and considered significant at P ≤ 0.05.ResultsOur results showed that SDH abundance and CS activity (mitochondrial biomarkers) were significantly greater (P = 0.01 and 0.003, respectively) in less tender samples when compared to more tender samples. On the other hand, PFK and GP activities (glycolytic biomarkers) were greater (P < 0.05) in the more tender than less tender steaks.ConclusionWhile not a cause and effect relationship, these data indicate that mitochondria content likely plays a role in development of beef tenderness.

Directions and Opportunities in Health Informatics in British Columbia

The social changes, and changes in perceptions of the effectiveness of health care in British Columbia have resulted in a large number of recommendations in the report of the British Columbia Royal Commission on Health Care and Costs. Many of these recommendations have implications for health informatics. The British Columbia Government, in outlining a response, foresees a major change in the emphases of health care, which will involve four major areas of health informatics: network evolution, automation of the patient record, outcome- and other quality-related databases, and consumer health education. These themes are discussed, in the light of the opinions of academics, health care providers, and the health-informatics industry. The themes must be intercalated into the health informatics curriculum, to equip graduates for the challenges of B.C.’s changing health care system.

Zinc methionine and laminarin have growth-enhancing properties in newly weaned pigs influencing both intestinal health and diarrhoea occurrence

Three experiments were conducted to investigate the interaction between zinc methionine (ZnM) and laminarin (LAM) on piglet growth performance and intestinal health post-weaning. Experiment 1 was designed as 2 × 2 factorial with four treatments [n = 8, weaning age (WA) 24 days, live weight (LW) 7.15 kg]: (i) basal diet (BD); (ii) BD + 500 mg/kg ZnM; (iii) BD + 300 mg/kg LAM; and (iv) BD + 500 mg/kg ZnM + 300 mg/kg LAM. There was an interaction (p < 0.05) between LAM and ZnM. Pigs that were offered the LAM diet had a similar performance to the BD. However, when combining LAM with ZnM, pigs had reduced average daily gain (ADG), gain-to-feed ratio (G:F) and LW at slaughter at day 8 post-weaning compared to the ZnM. Both LAM and ZnM improved the small intestinal morphology of the pigs at day 8 post-weaning. Experiment 2 was designed as 2 × 2 factorial with four dietary treatments (n = 9, WA 24 days, LW 7.32 kg): (i) BD; (ii) BD + 500 mg/kg ZnM; (iii) BD + 175 mg/kg LAM; and (iv) BD + 500 mg/kg ZnM + 175 mg/kg LAM. The ADG and average daily feed intake were improved between day 0 and 31 PW when pigs were offered a LAM diet (p < 0.01). Faecal scores were reduced between day 0 and day 31 post-weaning with ZnM (p < 0.001). Experiment 3 consisted of four dietary treatments (n = 10, WA 24 days, LW 7.32 kg): (i) BD; (ii) BD + 3300 mg/kg zinc oxide (ZnO); (iii) BD + 500 mg/kg ZnM; and (iv) BD + 175 mg/kg LAM. Pigs that were offered the ZnO diet had an increased ADG compared to the BD or ZnM diets (p < 0.01). Pigs that were offered the LAM diet had increased ADG compared to the ZnM diet (p < 0.05). Faecal scores were reduced between day 0 and day 31 PW with ZnM or ZnO supplementation (p < 0.001). In conclusion, the inclusion of 175 mg/kg LAM and ZnO improved ADG while both ZnO and ZnM reduced the faecal scores post-weaning.

The effect of algal polysaccharides laminarin and fucoidan on colonic pathology, cytokine gene expression and Enterobacteriaceae in a dextran sodium sulfate-challenged porcine model

The algal polysaccharides laminarin (LAM) and fucoidan (FUC) have potent anti-inflammatory activities in the gastrointestinal tract. Our objective was to examine the impact of prior consumption of LAM and/or FUC on pathology and inflammation following a dextran sodium sulfate (DSS) challenge in pigs. Pigs (n 7/group) were assigned to one of five experimental groups for 56 d. From 49-55 d, distilled water or DSS was administered intragastrically. The experimental groups were: (1) basal diet + distilled water (control); (2) basal diet + DSS (DSS); (3) basal diet + FUC + DSS (FUC + DSS); (4) basal diet + LAM + DSS (LAM + DSS); and (5) basal diet + LAM + FUC + DSS (LAMFUC + DSS). The DSS group had decreased body-weight gain (P < 0·05) and serum xylose (P < 0·05), and increased proximal colon pathology score (P < 0·05), diarrhoeal score (P < 0·001) and colonic Enterobacteriaceae (P < 0·05) relative to the control group. The FUC + DSS (P < 0·01), LAM + DSS (P < 0·05) and LAMFUC + DSS (P < 0·05) groups had improved diarrhoeal score, and the LAMFUC + DSS (P < 0·05) group had improved body weight relative to the DSS group. The FUC + DSS group (P < 0·001), LAM + DSS group (P < 0·05) and LAMFUC + DSS group (P < 0·001) had lower IL-6 mRNA abundance relative to the DSS group. The LAM + DSS group had reduced Enterobacteriaceae in proximal colon digesta relative to the DSS group (P < 0·05). In conclusion, FUC or a combination of FUC and LAM improved body-weight loss, diarrhoeal scores and clinical variables associated with a DSS challenge in pigs, in tandem with a reduction in colonic IL-6 mRNA abundance.

Maternal supplementation of seaweed-derived polysaccharides improves intestinal health and immune status of suckling piglets

The experiment investigated the effect of maternal dietary supplementation of seaweed-derived polysaccharides (SDP) (-SDP v. +SDP, n   20) from day 83 of gestation until weaning (day 28) on selected sow faeces and piglet digesta microbiota populations, piglet small-intestinal morphology, and intestinal nutrient transporter and inflammatory cytokine gene expression at birth, 48 h after birth and weaning. The effect of maternal dietary treatment on the piglet gene expression profile of inflammatory cytokines in the colon following a lipopolysaccharide (LPS) challenge was also investigated. Dietary SDP reduced sow faecal Enterobacteriaceae gene numbers at parturition. Small-intestinal morphology, nutrient transporter and cytokine gene expression in newborn piglets did not differ between maternal dietary treatments (P > 0·10). At 48 h after birth, sodium-glucose-linked transporter 1 gene expression was down-regulated in the ileum of piglets suckling the SDP-supplemented sows compared with those suckling the basal sows (P = 0·050). There was a SDP × LPS challenge interaction on IL-1 and IL-6 gene expression in the colon of piglets (P < 0·05). The gene expression of IL-1 and IL-6 was down-regulated in the LPS-challenged colon of piglets suckling the SDP sows compared with those suckling the basal sows (P < 0·05). However, there was no difference in IL-1 and IL-6 gene expression in the unchallenged colon between treatment groups. At weaning, piglets suckling the SDP-supplemented sows had increased villus height in the jejunum and ileum compared with those suckling the basal-fed sows (P < 0·05). In conclusion, maternal dietary SDP supplementation enhanced the immune response of suckling piglets and improved gut morphology, making them more immune competent to deal with post-weaning adversities.

Phase-field crystal model for a diamond-cubic structure

We present a structural phase-field crystal model [M. Greenwood et al., Phys. Rev. Lett. 105, 045702 (2010)] that yields a stable dc structure. The stabilization of a dc structure is accomplished by constructing a two-body direct correlation function (DCF) approximated by a combination of two Gaussian functions in Fourier space. A phase diagram containing a dc-liquid phase coexistence region is calculated for this model. We examine the energies of solid-liquid interfaces with normals along the [100], [110], and [111] directions. The dependence of the interfacial energy on a temperature parameter, which controls the heights of the peaks in the two-body DCF, is described by a Gaussian function. Furthermore, the dependence of the interfacial energy on the peak widths of the two-body DCF, which controls the excess energy associated with interfaces, defects, and strain, is described by an inverse power law. These relationships can be used to parametrize the phase-field crystal model for the dc structure to match solid-liquid interfacial energies to those measured experimentally or calculated from atomistic simulations.

Classical density functional theory and the phase-field crystal method using a rational function to describe the two-body direct correlation function

We introduce a new approach to represent a two-body direct correlation function (DCF) in order to alleviate the computational demand of classical density functional theory (CDFT) and enhance the predictive capability of the phase-field crystal (PFC) method. The approach utilizes a rational function fit (RFF) to approximate the two-body DCF in Fourier space. We use the RFF to show that short-wavelength contributions of the two-body DCF play an important role in determining the thermodynamic properties of materials. We further show that using the RFF to empirically parametrize the two-body DCF allows us to obtain the thermodynamic properties of solids and liquids that agree with the results of CDFT simulations with the full two-body DCF without incurring significant computational costs. In addition, the RFF can also be used to improve the representation of the two-body DCF in the PFC method. Last, the RFF allows for a real-space reformulation of the CDFT and PFC method, which enables descriptions of nonperiodic systems and the use of nonuniform and adaptive grids.

Performing the good death: the medieval Ars moriendi and contemporary doctors

Death is inevitable, but dying well is not. Despite the role of medical professionals as overseers of dying in contemporary society, there is comparatively little discourse among doctors about the constituents of a good death. In the 15th century, by contrast, the Ars moriendi portrayed normative medieval ideas about good and bad deaths. At a time when dying could be viewed as a performed battle against damnation, the Ars moriendi codified a set of moral precepts that governed the expression of autonomy, relations between the dying and the living and orientation towards God. In these images, dying well is a moral activity that results from active decisions by the dying person to turn from earthly preoccupations to contemplation of, and submission to, the divine. It is likely in contemporary society that there is a range of understandings of the "good death". While attitudes to personal autonomy may differ, reflectiveness and dying at home in the presence of family (expressed in the Ars moriendi), remain part of many modern notions of the good death. We argue that medical institutions continue to construct death as a performed battle against physical debility, even when patients may have different views of their preferred deaths. The dialectic approach of the Ars moriendi may offer a way for contemporary doctors to reflect critically on the potential dissonance between their own approach to death and the variety of culturally valorised "good deaths".

Coupled composition-deformation phase-field method for multicomponent lipid membranes

We present a method for modeling phase transitions and morphological evolution of binary lipid membranes with approximately planar geometries. The local composition and the shape of the membrane are coupled through composition-dependent spontaneous curvature in a Helfrich free energy. The evolution of the composition field is described by a Cahn-Hilliard-type equation, while shape changes are described by relaxation dynamics. Our method explicitly treats the full nonlinear form of the geometrical scalars, tensors, and differential operators associated with the curved shape of the membrane. The model is applied to examine morphological evolution and stability of lipid membranes initialized in a variety of compositional and geometric configurations. Specifically, we investigate the dynamics of systems which have a lamellar structure as their lowest energy state. We find that evolution is very sensitive to initial conditions; only membranes with sufficiently large lamellar-type compositional perturbations or ripple-type shape perturbations in their initial configuration can deterministically evolve into a lamellar equilibrium morphology. We also observe that rigid topographical surface patterns have a strong effect on the phase separation and compositional evolution in these systems.

Linear stability analysis for step meandering instabilities with elastic interactions and Ehrlich-Schwoebel barriers

Vicinal surfaces are known to exhibit morphological instabilities during step-flow growth. Through a linear stability analysis of step meandering instabilities, we investigate two effects that are important in many heteroepitaxial systems: elastic monopole-monopole interactions arising from bulk stress and the Ehrlich-Schwoebel (ES) barriers due to the asymmetric adatom incorporation rates. The analysis shows that the effects of the ES barriers increase as the average terrace width increases, whereas the effects of elastic monopole-monopole interactions decrease. The ES barriers favor an in-phase step pattern with a zero phase shift between consecutive steps, while elastic stress favors an out-of-phase pattern with a phase shift of pi. However, our analysis shows that the instability growth rate becomes nearly independent of the phase shift when either the ES-barrier effect or the stress effect is large. In particular, for ES-barrier-driven instability, the in-phase step pattern develops only within an intermediate range of terrace widths when bulk stress exists. Similarly, for the elastic-interaction-driven instability, an out-of-phase pattern only forms within a certain range of monopole strength; if the strength is too small, the ES barrier effect dominates, and if it is too large, the peak in the instability growth rate becomes delocalized in the phase shift and no patterns form. This transition between patterned and random step morphologies depends on the monopole strength, but is independent of the terrace width. A phase diagram that describes the regions of the ES-barrier-dominant instability and the elastic-interaction-dominant instability is established, along with the morphological phase diagrams that predict the step configurations as a function of the controlling parameters for the two types of instabilities.

Topological complexity and the dynamics of coarsening

Coarsening or Ostwald ripening occurs in a vast array of two-phase systems. Coarsening results in a decrease in the interfacial area per unit volume and a concomitant increase in the size scale of the interfacial morphology. Much is known about the coarsening process in two-phase mixtures consisting of a polydisperse array of spherical particles. In contrast, in many two-phase mixtures, such as those found in two-phase polymers, ceramics, dendritic solid-liquid mixtures and order-disorder transformations, the interfaces are both interconnected and have a spatially varying mean curvature. Here we show that the morphological evolution of these topologically complex systems during coarsening can be quantified by measuring the probability of finding a patch of interface with a given curvature tensor. We find that the morphological evolution is described by the flow of probability density in this curvature space that is induced by the coarsening process. The hallmark of our approach is a close coupling between experiment and theory; we use the experimentally measured three-dimensional microstructure as an input to a phase-field calculation that then determines the flow in curvature space. The methodology is general, and applicable to many systems undergoing coarsening, regardless of their topology.

An ERCC1 splicing variant involving the 5'-UTR of the mRNA may have a transcriptional modulatory function

Human ovarian cancer cells and tissues were examined for the presence or absence of a 42-bp splicing variant of ERCC1 gene, and for a possible functional role of this 42-bp sequence. This specific sequence exists in exon I, the 5'-UTR of the gene. Loss of this 42-bp sequence was associated with increased ERCC1 mRNA expression, in an assessment of 121 ovarian cancer specimens (p2<10(-6)). In cells in tissue culture, the absence of the 42-bp segment was associated with a twofold increased ability to drive transcription in a Luciferase reporter system. Protein can be demonstrated in ovarian cancer cells based on EMSA analysis. Computer analysis shows that this 42-bp sequence contains several binding sites, including a core-binding domain for protein RFX1, transcriptional repressor. These preliminary results lay the groundwork in determination of potential roles for a negative regulatory element in NER repair pathway.

Dynamics of late-stage phase separation in crystalline solids

The dynamics of Ostwald ripening in elastically stressed crystalline solids is determined through large-scale numerical simulations. Using the insight provided by the simulations, a theory for the dynamics of late-stage phase separation in elastically anisotropic homogeneous solids is developed. Both the theory and simulations show that for the systems considered elastic stress does not alter the exponent of the temporal power law for the average particle size but does affect the amplitude of the power law in a manner that is only a function of the symmetry of the particle morphology.

Improvement/rehabilitation of memory functioning with neurotherapy/QEEG biofeedback

This article presents a new approach to the remediation of memory deficits by studying the electrophysiological functioning involved in memory and applying biofeedback techniques. A Quantitative EEG (QEEG) activation database was obtained with 59 right-handed subjects during two auditory memory tasks (prose passages and word lists). Memory performance was correlated with the QEEG variables. Clinical cases were administered the same QEEG activation study to determine their deviations from the values that predicted success for the reference group. EEG biofeedback interventions were designed to increase the value (to normal levels) of the specific electrophysiological variable that was related to successful memory function and deviant in the subject. Case examples are presented that indicate the successful use of this intervention style in normal subjects and in subjects with brain injury; improvement cannot be fully explained by spontaneous recovery, given the time postinjury. Five cases (two normal, two subjects with brain injury, and one subject who had stereotactic surgery of the hippocampus for seizure control) are presented. Improvements ranged from 68% to 181% in the group of patients with brain injury, as a result of the interventions.

Increased mRNA levels of xeroderma pigmentosum complementation group B (XPB) and Cockayne's syndrome complementation group B (CSB) without increased mRNA levels of multidrug-resistance gene (MDR1) or metallothionein-II (MT-II) in platinum-resistant human ovarian cancer tissues

Tumor tissue specimens from human ovarian cancer patients were assessed for relative mRNA abundance levels of several genes thought to be involved in the development of in vitro drug resistance in this disease. Higher mRNA levels of Xeroderma pigmentosum group B (XPB), which links DNA repair with DNA transcription, and of Cockayne's syndrome group B (CSB), which is essential for gene-specific repair, were observed in tumor tissues that were clinically resistant to platinum-based chemotherapy, as compared with tissues from patients responding to therapy. In a cohort of 27 patients, mRNA levels of XPB averaged 5-fold higher in platinum-resistant tumors (P = 0.001); and for CSB, mRNA levels averaged 6-fold higher but with greater variability (P = 0.033). Concurrently, these platinum-resistant tumor tissues did not exhibit significantly higher mRNA levels for the MDR1 (multidrug-resistance) gene (P = 0.134) or of the metallothionein-II (MT-II) gene (P = 0.598). Since these platinum-resistant tumors also show higher mRNA levels of ERCC1 and XPA, platinum resistance appears to be associated with concurrent up-regulation of four genes (XPA, ERCC1, XPB, and CSB). These four genes participate in DNA damage excision activity, gene-specific repair, and linkage of DNA repair with DNA transcription. These data suggest that concurrent up-regulation of genes involved in nucleotide excision repair may be important in clinical resistance to platinum-based chemotherapy in this disease.

Evidence for in the appearance of mRNAs of nucleotide excision repair genes, in human ovarian cancer tissues

Nucleotide excision repair (NER) is the DNA repair pathway through which cisplatin-DNA intrastrand adduct is repaired. Clinical studies have shown that increased mRNA expression of selected genes involved in the rate-limiting step of NER, appear to be closely associated with clinical resistance to platinum agents. These specific studies have led to the possibility of an assessment of the order in which, the appearance of mRNAs of selected NER genes may occur. Included in this assessment are ERCC1, XPB, CSB, and XPA, studied in 28 ovarian cancer tumor tissue specimens. The study of these four genes, in pairs, from 28 ovarian cancer specimens, results in 168 separate observations. Based on the mRNA expression patterns of these genes in these tissues, it is suggested that ERCC1 mRNA may appear before the mRNA of any of the other genes, in an obligate fashion. This is followed by XPB mRNA; which appears before the mRNA of XPA; which in turn, may appear before CSB. This pattern is consistent with what we have reported previously, in non-malignant human bone marrow specimens from a cohort of 52 patients.

Computer based analyses of the 5'-flanking regions of selected genes involved in the nucleotide excision repair complex

We have previously observed that the mRNA of selected genes involved in nucleotide excision repair appear to be coordinately expressed in human tissues from patients with ovarian cancer, testicular cancer, malignant brain tumors, and other malignancies. Such genes include ERCC1, XPA, XPB, XPD, XPF, and XPG. Coordinate mRNA expression appears to be most impressive in non-malignant tissues. We therefore began to explore possible reasons why such coordinate expression should occur. DNA sequences for the above noted genes were obtained from GeneBank. Two different software programs were applied to the DNA sequence, to the area 5' to the start of exon I of each gene. Analyses were performed by computer. The length of the 5' area assessed, was based on previous reports that determined what portion of the genomic sequence comprised the 5' UTR of the promoter of the respective gene. Based on this approach, potential DNA binding sites for no less than three dozen proteins, were identified in the 5'-flanking region of each of the NER genes studied. For each gene, potential binding sites for activator proteins and for repressor proteins were identified. The 5'-flanking regions for each gene noted above, had binding sites in common for 14 proteins with transcription modulatory activity. Eleven of these proteins are known for activator activity; two are reported to have repressor activity, and one has both repressor and activator function. These data suggest a possible molecular basis for the previously observed coordinate mRNA expression of selected NER genes in human tissue specimens.

Domain growth in ternary fluids: A level set approach

We analyze phase separation in ternary systems in the asymptotic hydrodynamic regime when the volume fractions and concentrations are constant. The multiphase Navier-Stokes equations are solved using a level set method. A new projection method was developed to treat multiple junctions for systems with more than two phases. It is found that surface tension ratios can alter the growth mechanism of a minority phase in the presence of two majority phases. When the minority phase wets the interface of the majority phases the domain growth rate of all three phases is initially similar to that of a symmetric binary fluid but slows down at later times.