Bimekizumab for the treatment of moderate-to-severe plaque psoriasis: efficacy, safety, pharmacokinetics, pharmacodynamics and transcriptomics from a phase IIa, randomized, double-blind multicentre study

BACKGROUND

Bimekizumab is a monoclonal antibody that selectively inhibits both interleukin (IL)-17A and IL-17F, which is currently under investigation for treatment of moderate-to-severe plaque psoriasis. Maintenance dosing every 4 weeks is well established with IL-17 inhibitors for psoriasis.

OBJECTIVES

To investigate the possible dosing interval during bimekizumab maintenance therapy to maintain clear skin, to inform phase III studies.

METHODS

Forty-nine patients with moderate-to-severe plaque psoriasis received bimekizumab 320 mg at weeks 0/4, followed at week 16 by bimekizumab 320 mg (n = 17) or placebo (n = 32). Efficacy, safety, pharmacokinetics, immunogenicity and biopsy transcriptomic analyses were assessed to week 28.

RESULTS

At week 8, 47% of patients achieved a 100% improvement from baseline in Psoriasis Area and Severity Index (PASI 100), increasing to 57% at week 12 (8 weeks after the second dose) before decreasing. In those who received bimekizumab at week 16, PASI 100 rate increased to comparable peak levels at week 20, but reduced by week 28 to 41% (12 weeks after the third dose). The week 8 transcriptional signature observed in lesional psoriatic skin rapidly normalized to levels consistent with nonlesional skin, resulting in molecular remission. Keratinocyte-related gene products such as CXCL1 (C-X-C motif chemokine ligand 1), IL-8 (encoded by the CXCL8 gene), CCL20 (C-C motif chemokine 20), IL-36γ and IL-17C were profoundly normalized to levels associated with nonlesional skin.

CONCLUSIONS

Here, inhibition of IL-17F in addition to IL-17A resulted in rapid, deep clinical responses. Additionally, profound normalization of keratinocyte biology and the psoriatic transcriptome was observed, including normalization of both IL17 and IL23 gene expression by week 8. These data provide evidence to support evaluation of bimekizumab maintenance dosing both every 8 and every 4 weeks in phase III clinical trials.

Personalized nuclear imaging protocol in cases with nodular goiter and parathyroid adenoma

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules; the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious). Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. parathyroid localization, between cold vs. hot nodules, and eventually, for guiding the choice of a subsequent Fine-Needle Aspiration Biopsy (FNAB). Scans described an early intense ^99mTc-sestaMIBI uptake with no ^99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. In conclusion, using a ^99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of ^99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery.

VITAMIN D DEFICIENCY, A NONINVASIVE MARKER OF STEATOHEPATITIS IN PATIENTS WITH OBESITY AND BIOPSY PROVEN NONALCOHOLIC FATTY LIVER DISEASE

CONTEXT

Nonalcoholic fatty liver disease (NAFLD) includes simple steatosis, steatohepatitis (NASH) which can evolve with progressive fibrosis, cirrhosis and hepatocellular carcinoma. As liver biopsy cannot be used as a screening method, noninvasive markers are needed.

OBJECTIVE

The aim of this study was to test if there is a significant association between vitamin D deficit and the severity of NAFLD.

DESIGN

The patients were divided into two groups (vitamin D insufficiency/deficiency) and statistical analyses were performed on the correlation of clinical and biochemical characteristics with histopathological hepatic changes.

SUBJECTS AND METHODS

We prospectively studied 64 obese patients referred for bariatric surgery between 2014 and 2016 to our Surgical Unit. Anthropometric, clinical measurements, general and specific biological balance were noted. NAFLD diagnosis and activity score (NAS) were evaluated on liver biopsies.

RESULTS

Increased serum fibrinogen was correlated with NASH (p=0.005) and higher NAS grade. T2DM was positively correlated with liver fibrosis (p=0.002). 84.37% of the patients had vitamin D deficit and 15.62% were vitamin D insufficient. Lobular inflammation correlated with vitamin D deficit (p=0.040). Fibrosis (p=0.050) and steatohepatitis (p=0.032) were independent predictors of low vitamin D concentration.

CONCLUSIONS

Vitamin D status in conjunction with other parameters - such as T2DM - or serum biomarkers - namely fibrinogen level and PCR level - may point out the aggressive forms of NAFLD and the need for liver biopsy for appropriate management.

99mTc MIBI THYMIC SCINTIGRAPHY IN DIAGNOSIS AND THERAPEUTIC DECISION MAKING: WHAT IS BEHIND THE IMAGE?

CONTEXT

Despite CT being generally used in thymic pathology, in the case of regions with the same tissue density, only functional radioisotopic imaging can hint towards malignity.

OBJECTIVES

To assess the usefulness of 99mTc MIBI scintigraphy for diagnosis and treatment planning in thymoma, in relation with the radiotracer uptake mechanism.

PATIENTS AND METHODS

99mTc MIBI thymic scans for 19 patients diagnosed with thymic disorders were assessed using tumor uptake ratio (UR). Specimens of thymectomies were examined and cytological assessments were correlated with the UR.

RESULTS

The UR of all surgical patients was higher than 1.2, with a 1.5 cutoff between lymphoid hyperplasia and thymoma. The UR values were correlated with the histopathologic diagnosis (Pearson correlation 0.91, significant at p<0.01). The highest UR was 3.24, found in the case of an AB thymoma where the rate lymphocytes/epithelial cells (L/E) was 1.6. In B1 thymoma UR was 1.14 and L/E was 2.46.

CONCLUSION

Phenotype differences between thymoma types correlate with 99mTc MIBI cellular uptake: lower rate L/E corresponds to higher UR, higher malignity potential and invasiveness. A thymic 99mTc MIBI UR higher than 1.5, corresponding to a CT tumoral image, is suggestive for a thymoma, requiring surgical treatment first.

5 nm structures produced by direct laser writing

Here we present a new approach to overcome the optical diffraction limit by using novel materials. In the paper, we report experimental results obtained by high-resolution transmission electron microscopy (HRTEM) and optical absorption spectroscopy, for a fluorescent photosensitive glass-ceramic containing rare-earth ions such as samarium (Sm). Using a home built dynamic tester, with a low power laser, we recorded nanostructures having 5 nm line widths. In the line structure, measurements reveal the presence of silver nanocrystals with few nanometre sizes. HRTEM shows that there is a random orientation of the nanocrystals. A writing mechanism with three steps is proposed.

No relationship between insulin antibodies and transient remission in type 1 diabetic patients

It has been speculated that the insulin antibodies may contribute to the prevention of the onset of the transient remission in insulin-treated diabetic patients. To address this hypothesis, we analysed the titre of insulin antibodies (determined by RIA method, using polyethylenglycol separation technique and expressed as percentage of binding of insulin) in two groups of patients: group A: 46 type 1 diabetics, 25 males and 21 females aged 24 +/- 11.2 years, mean +/- SD, who did not manifest during the first period of the disease any clinical sign of remission; group B: 21 type I diabetics, 13 males and 8 females, aged 25.3 +/- 8.0 years, who manifested in the first year either a partial (18 cases) or a total (3 cases) transient remission. Thirty-eight of cases with disease onset before 1984 were treated with conventional insulins (27 of 46 cases in A group and 11 of 21 cases in B group); the remaining cases were treated with monocomponent (MC) insulins. The binding of the insulin was significantly higher in the patients treated with conventional insulins vs those treated with MC insulins, i.e., 18 +/- 7.1% vs 10.2 +/- 5.2% (p < 0.001). However, no difference was found in the binding of insulin in A group (14.5 +/- 1.3%) compared with B group (13.7 +/- 11.1%). Moreover, in 3 cases from B group the onset of the remission was coincident with the increase of insulin antibodies.

Insulin resistance: the link between impaired glucose tolerance, body mass index and plasma lipids

Body mass index defined as weight (Kg)/height (cm2) and plasma lipids (total lipids-TL, triglycerides-TG and cholesterol-CH) were determined in 131 patients (61 males and 70 females aged between 21 and 63 years) with impaired glucose tolerance (IGT) defined according to WHO criteria. Blood glucose (BG) values and plasma insulin (PI) levels (radioimmunological assay) were determined during 2 hours OGTT with samples obtained before and after 1 h and 2 h after the intake of 75 g glucose. The sum of blood glucose and plasma insulin levels (0 + 1h + 2h) were compared in each of the following 5 groups of subjects: A--25 cases with IGT but without obesity (BMI: 23.2 +/- 2.6) and hyperlipidaemia (PL: 627 +/- 112; TG: 102 +/- 109 and CH: 208 +/- 35 mg/dl); B--35 cases with IGT and obesity (BMI: 31.2 +/- 2.6) but without hyperlipidaemia (PL: 807 +/- 109; TG: 136 +/- 31 and CH: 254 +/- 41 mg/dl); C--23 cases with IGT and hyperlipidaemia (PL: 1013 +/- 217; TG: 214 +/- 85 and CH: 311 +/- 52 mg/dl) but without obesity (BMI: 25.4 +/- 1.9); D--48 cases with IGT and both obesity (BMI: 30.9 +/- 2.8) and hyperlipidaemia (PL: 1457 +/- 155; TG: 597 +/- 188 and CH: 483 +/- 184 mg/dl); a control group of 49 cases without IGT, obesity (BMI: 26.2 +/- 1.9) or hyperlipidaemia (PL: 726 +/- 99 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

Type I and type IV collagen promote adherence and spreading of human type II pneumocytes in vitro

Human lung tissue was enzymatically digested with dispase and type II pneumocytes were subsequently separated on a discontinuous metrizamide gradient. In primary adherence assays with freshly isolated cells, mean adherence values of 21.7, 19.6, 13.4, 6.8 and 7.0% were obtained after 48 hours on type I collagen (CI), type IV collagen (CIV), fibronectin (FN), laminin (LM) and tissue culture plastic, respectively. Secondly, readherence and spreading assays were performed with type II pneumocytes, previously cultured on CI, FN, matrix of murine EHS cells, and culture plastic. After a culture period of 48 to 72 hours, the cells were replated and tested on CI, CIV, FN, LM, CI + FN, CI + LM, CIV + FN and CIV + LM substrata in order to find out whether preculture substrata can modulate the adherence response of these cells. Readherence values, 1 hour after replating, were 3.3- to 8.6-fold higher than primary adherence values after 48 hours. The highest readherence values were always obtained on collagen-containing substrata after preculture on fibronectin. Spreading values after replating ranged between 35.4 and 6.6% on collagen-containing substrata, the highest values were again obtained after preculture on FN. Less than 6.9% and 0.5% of the cells spread on pure FN and pure LM, respectively. The data of the present investigation indicate that human type II pneumocytes adhere and spread preferentially on collagenous substrata rather than on other components of the extracellular matrix. This might be important in helping us to understand the functional in vivo activity of these cells, especially as regards re-epithelialization of the injured pulmonary alveolus.

Circulation of influenza virus A(H1N1) in Moldavia (Romania) during 1978-1982

The influenza virus A(H1N1) subtype that reappeared after an absence of 20 years was incriminated as an etiological agent of acute respiratory disease outbreaks in Moldavia (Romania). There were three epidemics in the winter--spring of 1978, 1979, and 1982, that affected mostly school communities and young adults. In 1980-1981 the circulation of A(H1N1) virus was limited. In all the epidemics mentioned the A(H1N1) subtype caused mild influenza cases, with minimal complications and insignificant mortality.

[Methodolgy and interpretation in the study of the complement system in chronic hepatitis]

The determination of the total hemolitic serum complement, as a screening test for investigating the activity of the entire complement system and the measurement of the C3 fraction consumption, has now gained a peculiar importance due to its contribution to the clearing up of some problems regarding the pathogeny an diagnosis of chronic hepatitis. The correlation of these values alterations with the presence of antiglobulinic antigens orientatively suggests the presence of immune complexes taking part in the maintainance of the inflammatory hepatic process.

Single haemolysis for the assay of antibodies to some haemagglutinating arboviruses

The single radial haemolysis reaction has been shown to be suitable for the quantitative assay of specific antibody to West Nile and Sindbis viruses. Only 5 mul of undiluted serum are needed for the test, which can be performed on crude preparations of antigen and without removal of nonspecific inhibitors. It is therefore a very simple procedure. Moreover, it appears to be more specific than the classical haemagglutination-inhibition tests.

[Posterior (retrovascular) mediastinocervical goiters]

Three cases are presented of endo-thoracic goiters with posterior, retro-vascular developement, a very rare variety of the mediastino-cervical goiter. The anatomic pathways are described, along which this variety of goiter can migrate inside the thorax, as well as the radiologic signs which allow to make a diagnosis. In view of making a choice of the access route the importance of the diagnosis is particularly stressed, before surgery is attempted. It is also demonstrated that the best route is the vertical cervicosternotomy of the partial type (the Welti technique), completed by antero-lateral thoracotomy in the III-rd right intercostal space.

[Details concerning a surgical technic in a case of esophagotracheal fistula]

The authors present a surgical technique for the treatment of oeso-tracheal fistula located in the left supra-hylar fossa, by mobilization of the aorta and ligature of the first intercostal arteries, which provide sufficient light for the surgical procedures. The technique described is illustrated by a personal observation demonstrating its value by the simplicity of the post-operative evolution and the complete recovery. Stressing the difficulty encountered in the pre- and intraoperative localization of the fistula, the authors consider that the technique proposed by them is the type of the necessity technique, the only one allowing to perform a direct surgical approach of the fistula at this level.

[Incomplete form of congenital megacolon]

The inapparent form is described, of a congenital megacolon. The surgical treatment consisted in an exeresis of more than 70 cm of volvular sigmoid, as well as of limitrophic areas supposed to be dystonic. Re-establishment of the continuity was achieved according to the technique of B. Duham 1, modified according to D. Vereanu and A. Pesamosca.

[A method of osteosynthesis in supracondylar transverse fracture of the humerus in children]

A new surgical technique is described for the osteosynthesis of the supra-condylar transversal fracture of the humerus in children with an unique central transolecranian and transcondylar brooch. Intra-operative radiography is indispensable. The position for immobilization is very important. Temporary perforation of the diarthrodial cartilage and of the conjugation cartilage does not lead to functional or osteogenesis disturbances.

A renin-like activity in pineal gland and hypophysis

The presence and distribution of renin-like activity in hypophysis, pineal gland and some neural tissues were studies in both normal and salt-loaded rats. The Boucher micromethod was used to detect enzymatic activity. In normal rats both the pituitary and pineal glands contained significantly higher values of renin-like activity than did the other tissues examined. In salt-loaded animals there was a significant decrease of the renin-like activity of the glandular tissue while in the other brain areas the activity increased. The results are discussed in terms of the possible physiological role of the central renin-angiotensin system in the regulation of fluid and electrolyte balance.