1
|
Alkaduhimi H, Hilgersom N, Eygendaal D, van den Bekerom M, Oh L. The Outcomes of Soft-Tissue Repair for Posterior Shoulder Instability Surgery. Arch Bone Jt Surg 2022; 10:45-51. [PMID: 35291236 PMCID: PMC8889426 DOI: 10.22038/abjs.2021.41491.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 04/11/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aimed to assess the results after soft-tissue posterior instability surgery and address possible challenges during these operations. METHODS The databases of two tertiary hospitals were reviewed to identify patients treated for posterior shoulder instability between 2000 and 2015. Out of 198 treated patients, 19 cases underwent surgery with a mean follow-up of 35 months. Chart review was performed to obtain recurrence rates, revision rates, return to sport, persistent pain, subjective instability, subjective feeling of being better, complications, and range of motion after operative treatment of posterior shoulder instability. These outcomes were compared using the Fisher's exact and Mann-Whitney U tests. RESULTS After surgery, 6 (32%) patients had a recurrent subluxation, and 11 (58%) cases had persistent pain; moreover, 5 (26%) patients had a persistent feeling of instability, and 10 (53%) cases did not feel improvement after the operation. Furthermore, 10 (53%) patients required a revision, and there were 7 (37%) cases with a complication. Postoperatively, 75% of the patients had a full forward flexion, and 93% of the cases had full internal rotation; however, 64% of them had restrictions in external rotation. CONCLUSION There is a high rate of recurrent instability, need for revision, and complications after soft-tissue posterior instability surgery. Postoperative external rotation was impaired in most patients. Patients should be informed about these unsatisfactory results.
Collapse
Affiliation(s)
- Hassanin Alkaduhimi
- Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A 2 Shoulder and elbow unit, Joint Research, OLVG Amsterdam, the Netherlands
| | - N.F.J. Hilgersom
- Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Denise Eygendaal
- Orthopaedic Department, Amphia Ziekenhuis, Breda, the Netherlands 3 Orthopaedic Department, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Luke Oh
- Massachusetts General Hospital, Orthopaedic Sports Department, Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
2
|
Ong CS, Oh L, Ghozy S, Dmytriw A, Mobbs R, Phan K, Dibas M, Faulkner H. 846 Dysphagia Rates in Single- And Multiple-Level Anterior Cervical Discectomy and Fusion Surgery: A Meta-Analysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
To conduct a meta-analysis to assess dysphagia complicating single-level and multiple-level (≥2) anterior cervical discectomy and fusion (ACDF) surgery.
Method
Electronic searches were performed using four electronic databases from their inception to December 2017. Relevant studies reporting the rate of dysphagia as an endpoint for patients undergoing ACDF for degenerative disease, myelopathy, cervical canal stenosis or ossification of the posterior longitudinal ligament were identified according to prior inclusion and exclusion criteria. Statistical analysis was performed using a fixed effect model. P-scores were used to rank the levels of ACDF based on the rate of dysphagia. I2 was used to explore heterogeneity.
Results
Ten studies were identified and included in the systematic review and meta-analysis, with a total of 4,018 patients identified; 2,362 patients underwent single-level ACDF, while 1,656 underwent multiple level (≥2 ACDF). The mean age ranged from 49.45 to 57.77 years. Mean follow-up time ranged from 2 days to 27.3 months. Overall, meta-analysis demonstrated a statistically significant higher dysphagia rate for multiple-level ACDF (6.6%) than for single-level ACDF (4%) (P heterogeneity =0.151, OR = 1.42, 95% CI: 1.05–1.91, I2=32%).
Conclusions
Dysphagia is a relatively common complication in the early postoperative period following ACDF and may cause patients significant discomfort and distress. This meta-analysis demonstrates a higher rate of dysphagia with multiple-level ACDF than with single-level ACDF at a period of 12–24 months.
Collapse
Affiliation(s)
- C S Ong
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - L Oh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - S Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - A Dmytriw
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - R Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - K Phan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Neurospine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
| | - M Dibas
- Sulaiman Al Rajhi Colleges, College of Medicine, Al Bukayriyah, Saudi Arabia
| | - H Faulkner
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
3
|
Karmila AB, Yap YC, Appadurai M, Oh L, Fazarina M, Abd Ghani F, Ariffin H. Focal Segmental Membranoproliferative Glomerulonephritis: A Histological Variant of Denys-Drash Syndrome. Fetal Pediatr Pathol 2021; 40:113-120. [PMID: 31707902 DOI: 10.1080/15513815.2019.1686788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Denys-Drash Syndrome (DDS) consists of a triad of pseudohermaphroditism, Wilms'tumor and nephropathy. This condition may manifest as a complete triad or in an incomplete form; with either one or a combination of the above features. The characteristic glomerular abnormality in DDS is diffuse mesangial sclerosis (DMS).Case report: We report two cases of DDS with focal membranoproliferative glomerulonephritis (MPGN). Both of our cases were males with ambiguous genitalia. They had a similar heterozygous germline mutation in exon 9 of WT1, c.1180C>T, p.R394W; a known mutation hotspot for DDS. Case 1 had nephropathy at the age of 4 years and Case 2 at 2.5 years with different rates of progression to end-stage renal failure. Conclusion: Our findings, in combination with other reports, illustrate the clinicopathological heterogeneity of DDS. There are no universal recommendations for optimal management of patients with DDS due to the inability to accurately predict affected individuals' progress.
Collapse
Affiliation(s)
- A B Karmila
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Y C Yap
- Paediatric Renal Unit, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - M Appadurai
- Paediatric Renal Unit, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - L Oh
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - M Fazarina
- Department of Laboratory Diagnostic Services, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - F Abd Ghani
- Faculty of Medicine and Health Sciences, Department of Pathology, Universiti Putra Malaysia, Selangor, Malaysia
| | - H Ariffin
- Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
4
|
Matta MK, Florian J, Zusterzeel R, Pilli NR, Patel V, Volpe DA, Yang Y, Oh L, Bashaw E, Zineh I, Sanabria C, Kemp S, Godfrey A, Adah S, Coelho S, Wang J, Furlong LA, Ganley C, Michele T, Strauss DG. Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA 2020; 323:256-267. [PMID: 31961417 PMCID: PMC6990686 DOI: 10.1001/jama.2019.20747] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A prior pilot study demonstrated the systemic absorption of 4 sunscreen active ingredients; additional studies are needed to determine the systemic absorption of additional active ingredients and how quickly systemic exposure exceeds 0.5 ng/mL as recommended by the US Food and Drug Administration (FDA). OBJECTIVE To assess the systemic absorption and pharmacokinetics of the 6 active ingredients (avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octinoxate) in 4 sunscreen products under single- and maximal-use conditions. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at a clinical pharmacology unit (West Bend, Wisconsin) was conducted in 48 healthy participants. The study was conducted between January and February 2019. INTERVENTIONS Participants were randomized to 1 of 4 sunscreen products, formulated as lotion (n = 12), aerosol spray (n = 12), nonaerosol spray (n = 12), and pump spray (n = 12). Sunscreen product was applied at 2 mg/cm2 to 75% of body surface area at 0 hours on day 1 and 4 times on day 2 through day 4 at 2-hour intervals, and 34 blood samples were collected over 21 days from each participant. MAIN OUTCOMES AND MEASURES The primary outcome was the maximum plasma concentration of avobenzone over days 1 through 21. Secondary outcomes were the maximum plasma concentrations of oxybenzone, octocrylene, homosalate, octisalate, and octinoxate over days 1 through 21. RESULTS Among 48 randomized participants (mean [SD] age, 38.7 [13.2] years; 24 women [50%]; 23 white [48%], 23 African American [48%], 1 Asian [2%], and 1 of unknown race/ethnicity [2%]), 44 (92%) completed the trial. Geometric mean maximum plasma concentrations of all 6 active ingredients were greater than 0.5 ng/mL, and this threshold was surpassed on day 1 after a single application for all active ingredients. For avobenzone, the overall maximum plasma concentrations were 7.1 ng/mL (coefficient of variation [CV], 73.9%) for lotion, 3.5 ng/mL (CV, 70.9%) for aerosol spray, 3.5 ng/mL (CV, 73.0%) for nonaerosol spray, and 3.3 ng/mL (CV, 47.8%) for pump spray. For oxybenzone, the concentrations were 258.1 ng/mL (CV, 53.0%) for lotion and 180.1 ng/mL (CV, 57.3%) for aerosol spray. For octocrylene, the concentrations were 7.8 ng/mL (CV, 87.1%) for lotion, 6.6 ng/mL (CV, 78.1%) for aerosol spray, and 6.6 ng/mL (CV, 103.9%) for nonaerosol spray. For homosalate, concentrations were 23.1 ng/mL (CV, 68.0%) for aerosol spray, 17.9 ng/mL (CV, 61.7%) for nonaerosol spray, and 13.9 ng/mL (CV, 70.2%) for pump spray. For octisalate, concentrations were 5.1 ng/mL (CV, 81.6%) for aerosol spray, 5.8 ng/mL (CV, 77.4%) for nonaerosol spray, and 4.6 ng/mL (CV, 97.6%) for pump spray. For octinoxate, concentrations were 7.9 ng/mL (CV, 86.5%) for nonaerosol spray and 5.2 ng/mL (CV, 68.2%) for pump spray. The most common adverse event was rash, which developed in 14 participants. CONCLUSIONS AND RELEVANCE In this study conducted in a clinical pharmacology unit and examining sunscreen application among healthy participants, all 6 of the tested active ingredients administered in 4 different sunscreen formulations were systemically absorbed and had plasma concentrations that surpassed the FDA threshold for potentially waiving some of the additional safety studies for sunscreens. These findings do not indicate that individuals should refrain from the use of sunscreen. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03582215.
Collapse
Affiliation(s)
- Murali K. Matta
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Jeffry Florian
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Robbert Zusterzeel
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Nageswara R. Pilli
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Vikram Patel
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Donna A. Volpe
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Yang Yang
- Division of Pharmaceutical Quality Research, Office of Testing and Research, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Luke Oh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Edward Bashaw
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Issam Zineh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Sarah Kemp
- Spaulding Clinical Research, West Bend, Wisconsin
| | | | - Steven Adah
- Division of Nonprescription Drug Products, Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Sergio Coelho
- Division of Nonprescription Drug Products, Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Jian Wang
- Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Lesley-Anne Furlong
- Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Charles Ganley
- Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Theresa Michele
- Division of Nonprescription Drug Products, Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - David G. Strauss
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
5
|
Oh L, Yi S, Zhang D, Shin SH, Bashaw E. In Vitro Skin Permeation Methodology for Over-The-Counter Topical Dermatologic Products. Ther Innov Regul Sci 2019:2168479019875338. [PMID: 31581817 DOI: 10.1177/2168479019875338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
For topically applied over-the-counter (OTC) products, the association of unwanted systemic exposure and adverse events may be difficult to ascertain without a recognition or determination of in vivo absorption. Evaluation of skin permeability using a validated in vitro permeation methodology can provide important information for both initial formulation selection and reformulation during the product life cycle. Additionally, a comparison of permeation rates between formulations using a validated methodology could reduce the number of nonclinical studies needed as part of reformulation. However, many in vitro permeation tests (IVPTs) have produced results with high variability and low reproducibility between study sites. It is unclear if this is due to a lack of a standardized protocol, or lack of control of multiple key experimental factors including skin source, preparation, receptor fluid, and study design. This review presents the authors perspective on the potential regulatory utility of IVPT and proposes steps to improve the accuracy and reproducibility of IVPT. The focus of this review is on topical dermatologic drugs with an initial emphasis on the OTC marketplace where reformulations are more common.
Collapse
Affiliation(s)
- Luke Oh
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Silver Spring, MD, USA
| | - Sojeong Yi
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Silver Spring, MD, USA
| | - Da Zhang
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Silver Spring, MD, USA
| | - Soo Hyeon Shin
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Silver Spring, MD, USA
| | - Edward Bashaw
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Clinical Pharmacology, Silver Spring, MD, USA
| |
Collapse
|
6
|
Matta MK, Zusterzeel R, Pilli NR, Patel V, Volpe DA, Florian J, Oh L, Bashaw E, Zineh I, Sanabria C, Kemp S, Godfrey A, Adah S, Coelho S, Wang J, Furlong LA, Ganley C, Michele T, Strauss DG. Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA 2019; 321:2082-2091. [PMID: 31058986 PMCID: PMC6549296 DOI: 10.1001/jama.2019.5586] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The US Food and Drug Administration (FDA) has provided guidance that sunscreen active ingredients with systemic absorption greater than 0.5 ng/mL or with safety concerns should undergo nonclinical toxicology assessment including systemic carcinogenicity and additional developmental and reproductive studies. OBJECTIVE To determine whether the active ingredients (avobenzone, oxybenzone, octocrylene, and ecamsule) of 4 commercially available sunscreens are absorbed into systemic circulation. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at a phase 1 clinical pharmacology unit in the United States and enrolling 24 healthy volunteers. Enrollment started in July 2018 and ended in August 2018. INTERVENTIONS Participants were randomized to 1 of 4 sunscreens: spray 1 (n = 6 participants), spray 2 (n = 6), a lotion (n = 6), and a cream (n = 6). Two milligrams of sunscreen per 1 cm2 was applied to 75% of body surface area 4 times per day for 4 days, and 30 blood samples were collected over 7 days from each participant. MAIN OUTCOMES AND MEASURES The primary outcome was the maximum plasma concentration of avobenzone. Secondary outcomes were the maximum plasma concentrations of oxybenzone, octocrylene, and ecamsule. RESULTS Among 24 participants randomized (mean age, 35.5 [SD, 1.5] years; 12 (50%] women; 14 [58%] black or African American; 14 [58%]), 23 (96%) completed the trial. For avobenzone, geometric mean maximum plasma concentrations were 4.0 ng/mL (coefficient of variation, 6.9%) for spray 1; 3.4 ng/mL (coefficient of variation, 77.3%) for spray 2; 4.3 ng/mL (coefficient of variation, 46.1%) for lotion; and 1.8 ng/mL (coefficient of variation, 32.1%). For oxybenzone, the corresponding values were 209.6 ng/mL (66.8%) for spray 1, 194.9 ng/mL (52.4%) for spray 2, and 169.3 ng/mL (44.5%) for lotion; for octocrylene, 2.9 ng/mL (102%) for spray 1, 7.8 ng/mL (113.3%) for spray 2, 5.7 ng/mL (66.3%) for lotion, and 5.7 ng/mL (47.1%) for cream; and for ecamsule, 1.5 ng/mL (166.1%) for cream. Systemic concentrations greater than 0.5 ng/mL were reached for all 4 products after 4 applications on day 1. The most common adverse event was rash, which developed in 1 participant with each sunscreen. CONCLUSIONS AND RELEVANCE In this preliminary study involving healthy volunteers, application of 4 commercially available sunscreens under maximal use conditions resulted in plasma concentrations that exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens. The systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings. These results do not indicate that individuals should refrain from the use of sunscreen. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03582215.
Collapse
Affiliation(s)
- Murali K. Matta
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Robbert Zusterzeel
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Nageswara R. Pilli
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Vikram Patel
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Donna A. Volpe
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Jeffry Florian
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Luke Oh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Edward Bashaw
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Issam Zineh
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Sarah Kemp
- Spaulding Clinical Research, West Bend, Wisconsin
| | | | - Steven Adah
- Division of Nonprescription Drug Products, Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Sergio Coelho
- Division of Nonprescription Drug Products, Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Jian Wang
- Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Lesley-Anne Furlong
- Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Charles Ganley
- Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Theresa Michele
- Division of Nonprescription Drug Products, Office of Drug Evaluation IV, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - David G. Strauss
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
7
|
Lavery KP, Bernazzani M, McHale K, Rossy W, Oh L, Theodore G. Mini-Open Posterior Compartment Release for Chronic Exertional Compartment Syndrome of the Leg. Arthrosc Tech 2017; 6:e649-e653. [PMID: 28706812 PMCID: PMC5495562 DOI: 10.1016/j.eats.2017.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/18/2017] [Indexed: 02/03/2023] Open
Abstract
Chronic exertional compartment syndrome (CECS) is a well-recognized cause of leg pain in endurance athletes. Surgical fasciotomy for posterior leg CECS historically has inferior clinical results compared with anterior and lateral compartment release. Poor surgical technique with inadequate release may contribute to less reliable outcomes. In this Technical Note with accompanying video, we describe a mini-open approach for posterior CECS of the leg.
Collapse
Affiliation(s)
- Kyle P. Lavery
- Address correspondence to Kyle P. Lavery, M.D., Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, U.S.A.Division of Sports MedicineDepartment of Orthopaedic SurgeryMassachusetts General Hospital175 Cambridge Street4th FloorBostonMA02114U.S.A.
| | | | | | | | | | | |
Collapse
|
8
|
Wright AD, Sharma P, Zweifel B, Oh L. Suppression of acute uveitis following treatment with repository corticotropin injection. The Journal of Immunology 2017. [DOI: 10.4049/jimmunol.198.supp.127.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Repository corticotropin injection (RCI: H.P. Acthar® gel) contains a purified porcine pituitary ACTH-analogue, and is an FDA-approved treatment for several inflammatory eye diseases. ACTH binds to all 5 known melanocortin receptors and may suppress inflammation by steroid-dependent and independent pathways. Endotoxin-induced uveitis (EIU) in rodents is a useful experimental model to investigate mechanism of action and pharmacological efficacy of potential treatments. This study was conducted to investigate the potential anti-inflammatory benefit of RCI in an acute rat model of EIU. EIU is characterized by clinically relevant signs of inflammation, including inflammatory cytokines and cells in the anterior and vitreous chambers. Rats (n=16 group) were treated with dexamethasone (Dex), placebo, or RCI at 160 IU/kg, 400 IU/kg or 800 IU/kg following EIU induction. Eyes were clinically examined at pre-challenge, 6–8, 24, and 48 hours post LPS challenge using the Combined Draize and McDonald – Shadduck Scoring System.
Treatment GroupOcular Clinical Score (mean ± sem)IL-1a (pg/ml) (mean ± sem)MIP2a (pg/ml) (mean ± sem)Placebo15.5 ± 1.2207.1 ± 68.9240 ± 47Acthar 160 IU/kg9.4 ± 1.0130.3 ± 34.6158 ± 43Acthar 400IU/kg2.0 ± 0.3*95.7 ± 20.3114 ± 18*Acthar 800 IU/kg0.9 ± 0.2*50.9 ± 8.3*126 ± 32*Dex2.6 ± 0.5*54.4 ± 10.5*92 ± 10**= p ≤ 0.01
We show that RCI treatment significantly reduced ocular inflammation and inflammatory cytokines in an EIU model of acute uveitis. RCI has the potential opportunity to be therapeutic for a wide range of inflammatory and autoimmune diseases, including uveitis. The mechanism of action of RCI may involve more than the induction of corticosteroids, and will be explored further in future studies.
Collapse
Affiliation(s)
| | | | | | - Luke Oh
- 1Mallinckrodt Pharmaceuticals
| |
Collapse
|
9
|
Farmer LJ, Ledeboer MW, Hoock T, Arnost MJ, Bethiel RS, Bennani YL, Black JJ, Brummel CL, Chakilam A, Dorsch WA, Fan B, Cochran JE, Halas S, Harrington EM, Hogan JK, Howe D, Huang H, Jacobs DH, Laitinen LM, Liao S, Mahajan S, Marone V, Martinez-Botella G, McCarthy P, Messersmith D, Namchuk M, Oh L, Penney MS, Pierce AC, Raybuck SA, Rugg A, Salituro FG, Saxena K, Shannon D, Shlyakter D, Swenson L, Tian SK, Town C, Wang J, Wang T, Wannamaker MW, Winquist RJ, Zuccola HJ. Discovery of VX-509 (Decernotinib): A Potent and Selective Janus Kinase 3 Inhibitor for the Treatment of Autoimmune Diseases. J Med Chem 2015; 58:7195-216. [DOI: 10.1021/acs.jmedchem.5b00301] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Luc J. Farmer
- Vertex Pharmaceuticals (Canada) Inc., 275 Armand-Frappier, Laval, Québec H7V 4A7, Canada
| | - Mark W. Ledeboer
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Thomas Hoock
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Michael J. Arnost
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Randy S. Bethiel
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Youssef L. Bennani
- Vertex Pharmaceuticals (Canada) Inc., 275 Armand-Frappier, Laval, Québec H7V 4A7, Canada
| | - James J. Black
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Christopher L. Brummel
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | | | - Warren A. Dorsch
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Bin Fan
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - John E. Cochran
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Summer Halas
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Edmund M. Harrington
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - James K. Hogan
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - David Howe
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Hui Huang
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Dylan H. Jacobs
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Leena M. Laitinen
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Shengkai Liao
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Sudipta Mahajan
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Valerie Marone
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | | | - Pamela McCarthy
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - David Messersmith
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Mark Namchuk
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Luke Oh
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Marina S. Penney
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Albert C. Pierce
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Scott A. Raybuck
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Arthur Rugg
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Francesco G. Salituro
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Kumkum Saxena
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Dean Shannon
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Dina Shlyakter
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Lora Swenson
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Shi-Kai Tian
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Christopher Town
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Jian Wang
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Tiansheng Wang
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - M. Woods Wannamaker
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Raymond J. Winquist
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| | - Harmon J. Zuccola
- Vertex Pharmaceuticals Inc., 50 Northern Avenue, Boston, Massachusetts 02210, United States
| |
Collapse
|
10
|
Mahajan S, Hogan JK, Shlyakhter D, Oh L, Salituro FG, Farmer L, Hoock TC. VX-509 (decernotinib) is a potent and selective janus kinase 3 inhibitor that attenuates inflammation in animal models of autoimmune disease. J Pharmacol Exp Ther 2015; 353:405-14. [PMID: 25762693 DOI: 10.1124/jpet.114.221176] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Cytokines, growth factors, and other chemical messengers rely on a class of intracellular nonreceptor tyrosine kinases known as Janus kinases (JAKs) to rapidly transduce intracellular signals. A number of these cytokines are critical for lymphocyte development and mediating immune responses. JAK3 is of particular interest due to its importance in immune function and its expression, which is largely confined to lymphocytes, thus limiting the potential impact of JAK3 inhibition on nonimmune physiology. The aim of this study was to evaluate the potency and selectivity of the investigational JAK3 inhibitor VX-509 (decernotinib) [(R)-2-((2-(1H-pyrrolo[2,3-b]pyridin-3-yl)pyrimidin-4-yl)amino)-2-methyl-N-(2,2,2-trifluoroethyl)butanamide] against JAK3 kinase activity and inhibition of JAK3-mediated signaling in vitro and JAK3-dependent physiologic processes in vivo. These results demonstrate that VX-509 potently inhibits JAK3 in enzyme assays (Ki = 2.5 nM + 0.7 nM) and cellular assays dependent on JAK3 activity (IC50 range, 50-170 nM), with limited or no measurable potency against other JAK isotypes or non-JAK kinases. VX-509 also showed activity in two animal models of aberrant immune function. VX-509 treatment resulted in dose-dependent reduction in ankle swelling and paw weight and improved paw histopathology scores in the rat collagen-induced arthritis model. In a mouse model of oxazolone-induced delayed-type hypersensitivity, VX-509 reduced the T cell-mediated inflammatory response in skin. These findings demonstrate that VX-509 is a selective and potent inhibitor of JAK3 in vitro and modulates proinflammatory response in models of immune-mediated diseases, such as collagen-induced arthritis and delayed-type hypersensitivity. The data support evaluation of VX-509 for treatment of patients with autoimmune and inflammatory diseases such as rheumatoid arthritis.
Collapse
Affiliation(s)
- Sudipta Mahajan
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| | - James K Hogan
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| | - Dina Shlyakhter
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| | - Luke Oh
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| | - Francesco G Salituro
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| | - Luc Farmer
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| | - Thomas C Hoock
- Departments of Integrated Biology and Chemistry, Vertex Pharmaceuticals, Boston, Massachusetts (S.M., J.K.H., D.S., L.F., T.C.H.); Sage Therapeutics, Cambridge, Massachusetts (F.G.S.); and Mallinckrodt Pharmaceuticals, Ellicott City, Maryland (L.O.)
| |
Collapse
|
11
|
Cusick MF, Libbey JE, Oh L, Jordan S, Fujinami RS. Acthar gel treatment suppresses acute exacerbations in a murine model of relapsing-remitting multiple sclerosis. Autoimmunity 2014; 48:222-30. [PMID: 25410153 DOI: 10.3109/08916934.2014.984836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acthar gel is indicated for the treatment of acute exacerbations of multiple sclerosis (MS) in adults. Its effects on immune cells during a relapse are unknown. This study investigated the effects of Acthar in an animal model of relapsing-remitting MS, using SJL/J mice sensitized with myelin peptide. All animal studies were reviewed and approved by the University of Utah Institutional Animal Care and Use Committee and conducted in accordance with the guidelines prepared by the Committee on Care and Use of Laboratory Animals, Institute of Laboratory Animals Resources, National Research Council. Mice injected with Acthar to treat the second attack had a significantly lower mean clinical score during relapse and a significantly reduced cumulative disease burden compared to Placebo gel-treated mice. Furthermore, Acthar treatment ameliorated inflammation/demyelination in the spinal cord and markedly suppressed ex vivo myelin peptide-induced CD4(+) T cell proliferation.
Collapse
Affiliation(s)
- Matthew F Cusick
- Department of Pathology, University of Utah , Salt Lake City, UT , USA and
| | | | | | | | | |
Collapse
|
12
|
Ariffin H, Chan ASL, Oh L, Abd-Ghafar S, Ong GB, Mohamed M, Razali H, Juraida E, Teo SH, Karsa M, Shamsani J, Hainaut P. Frequent occurrence of gastric cancer in Asian kindreds with Li-Fraumeni syndrome. Clin Genet 2014; 88:450-5. [PMID: 25318593 DOI: 10.1111/cge.12525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/24/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022]
Abstract
Type of cancer and age of onset in individuals with inherited aberrations in the tumour suppressor gene TP53 are variable, possibly influenced by genetic modifiers and different environmental exposure. Since 2009, the modified Chompret criteria (MCC) have been used to identify individuals for TP53 mutation screening. Using the TP53 mutation database maintained by the International Agency for Research on Cancer (IARC), we investigated if the MCC, mainly developed for a Caucasian population, was also applicable in Asia. We identified several differences in Asian families compared with similar Caucasian cohorts, suggesting that identification and management of Li-Fraumeni syndrome in Asia do not completely mirror that of North America and Western Europe. Early gastric cancer (<40 years) may be considered a new addition to the MCC especially for Asian families.
Collapse
Affiliation(s)
- H Ariffin
- University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia.,Paediatric Haematology-Oncology Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - A S L Chan
- Paediatric Haematology-Oncology Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - L Oh
- University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - S Abd-Ghafar
- University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - G B Ong
- Department of Paediatrics, Sarawak General Hospital, Sarawak, Malaysia
| | - M Mohamed
- Paediatrics Institute, Kuala Lumpur, Malaysia
| | - H Razali
- Department of Paediatrics, Sultan Ismail Hospital, Johor Bahru, Malaysia
| | - E Juraida
- Paediatrics Institute, Kuala Lumpur, Malaysia
| | - S H Teo
- Cancer Research Initiatives Foundation, Subang Jaya, Malaysia
| | - M Karsa
- University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - J Shamsani
- University of Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - P Hainaut
- Institut Albert Bonniot - INSERM 823, University Grenoble-Alpes, Grenoble, France
| |
Collapse
|
13
|
Decker DA, Grant C, Oh L, Becker PM, Young D, Jordan S. Immunomodulatory effects of H.P. Acthar Gel on B cell development in the NZB/W F1 mouse model of systemic lupus erythematosus. Lupus 2014; 23:802-12. [DOI: 10.1177/0961203314531840] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 03/17/2014] [Indexed: 12/29/2022]
Abstract
H.P. Acthar Gel® (Acthar) is a highly purified repository gel preparation of adrenocorticotropic hormone (ACTH1-39), a melanocortin peptide that can bind and activate specific receptors expressed on a range of systemic lupus erythematosus (SLE)-relevant target cells and tissues. This study was performed to evaluate the effects of Acthar in a mouse model of SLE, using an F1 hybrid of the New Zealand Black and New Zealand White strains (NZB/W F1). Twenty-eight week old NZB/W F1 mice with established autoimmune disease were treated with Acthar, Placebo Gel (Placebo), or prednisolone and monitored for 19 weeks. Outcomes assessed included disease severity (severe proteinuria, ≥ 20% body weight loss, or prostration), measurement of serial serum autoantibody titers, terminal spleen immunophenotyping, and evaluation of renal histopathology. Acthar treatment was linked with evidence of altered B cell differentiation and development, manifested by a significant reduction in splenic B cell follicular and germinal center cells, and decreased levels of circulating total and anti-double-stranded DNA (IgM, IgG, and IgG2a) autoantibodies as compared with Placebo. Additionally, Acthar treatment resulted in a significant decrease of proteinuria, reduced renal lymphocyte infiltration, and attenuation of glomerular immune complex deposition. These data suggest that Acthar diminished pathogenic autoimmune responses in the spleen, peripheral blood, and kidney of NZB/W F1 mice. This is the first preclinical evidence demonstrating Acthar's potential immunomodulatory activity and efficacy in a murine model of systemic lupus erythematosus.
Collapse
Affiliation(s)
- DA Decker
- Questcor Pharmaceuticals Inc., Ellicott City, MD, USA
| | - C Grant
- Biomedical Research Models, Inc., Worcester, MA, USA
| | - L Oh
- Questcor Pharmaceuticals Inc., Ellicott City, MD, USA
| | - PM Becker
- Questcor Pharmaceuticals Inc., Ellicott City, MD, USA
| | - D Young
- Questcor Pharmaceuticals Inc., Ellicott City, MD, USA
| | - S Jordan
- Questcor Pharmaceuticals Inc., Ellicott City, MD, USA
| |
Collapse
|
14
|
Anwar Jagessar S, Fagrouch Z, Heijmans N, Bauer J, Laman JD, Oh L, Migone T, Verschoor EJ, ’t Hart BA. The Different Clinical Effects of Anti-BLyS, Anti-APRIL and Anti-CD20 Antibodies Point at a Critical Pathogenic Role of γ-Herpesvirus Infected B Cells in the Marmoset EAE Model. J Neuroimmune Pharmacol 2013; 8:727-38. [DOI: 10.1007/s11481-013-9448-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
|
15
|
Luster TA, Mukherjee I, Carrell JA, Cho YH, Gill J, Kelly L, Garcia A, Ward C, Oh L, Ullrich SJ, Migone TS, Humphreys R. Fusion toxin BLyS-gelonin inhibits growth of malignant human B cell lines in vitro and in vivo. PLoS One 2012; 7:e47361. [PMID: 23056634 PMCID: PMC3467252 DOI: 10.1371/journal.pone.0047361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/11/2012] [Indexed: 12/28/2022] Open
Abstract
B lymphocyte stimulator (BLyS) is a member of the TNF superfamily of cytokines. The biological activity of BLyS is mediated by three cell surface receptors: BR3/BAFF-R, TACI and BCMA. The expression of these receptors is highly restricted to B cells, both normal and malignant. A BLyS-gelonin fusion toxin (BLyS-gel) was generated consisting of the recombinant plant-derived toxin gelonin fused to the N-terminus of BLyS and tested against a large and diverse panel of B-NHL cell lines. Interestingly, B-NHL subtypes mantle cell lymphoma (MCL), diffuse large B cell lymphoma (DLBCL) and B cell precursor-acute lymphocytic leukemia (BCP-ALL) were preferentially sensitive to BLyS-gel mediated cytotoxicity, with low picomolar EC50 values. BLyS receptor expression did not guarantee sensitivity to BLyS-gel, even though the construct was internalized by both sensitive and resistant cells. Resistance to BLyS-gel could be overcome by treatment with the endosomotropic drug chloroquine, suggesting BLyS-gel may become trapped within endosomal/lysosomal compartments in resistant cells. BLyS-gel induced cell death was caspase-independent and shown to be at least partially mediated by the “ribotoxic stress response.” This response involves activation of p38 MAPK and JNK/SAPK, and BLyS-gel mediated cytotoxicity was inhibited by the p38/JNK inhibitor SB203580. Finally, BLyS-gel treatment was shown to localize to sites of disease, rapidly reduce tumor burden, and significantly prolong survival in xenograft mouse models of disseminated BCP-ALL, DLBCL, and MCL. Together, these findings suggest BLyS has significant potential as a targeting ligand for the delivery of cytotoxic “payloads” to malignant B cells.
Collapse
Affiliation(s)
- Troy A. Luster
- Department of Oncology Research, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Ipsita Mukherjee
- Department of Oncology Research, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Jeffrey A. Carrell
- Department of Lead Development, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Yun Hee Cho
- Department of Lead Development, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Jeffrey Gill
- Department of Lead Development, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Lizbeth Kelly
- Department of Immunology Research, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Andy Garcia
- Department of Lead Development, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Christopher Ward
- Department of Lead Development, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Luke Oh
- Department of Immunology Research, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Stephen J. Ullrich
- Department of Lead Development, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Thi-Sau Migone
- Department of Immunology Research, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
| | - Robin Humphreys
- Department of Oncology Research, Human Genome Sciences, Inc., Rockville, Maryland, United States of America
- * E-mail:
| |
Collapse
|
16
|
Jagessar SA, Heijmans N, Oh L, Bauer J, Blezer ELA, Laman JD, Migone TS, Devalaraja MN, 't Hart BA. Antibodies against human BLyS and APRIL attenuate EAE development in marmoset monkeys. J Neuroimmune Pharmacol 2012; 7:557-70. [PMID: 22870852 PMCID: PMC3419352 DOI: 10.1007/s11481-012-9384-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 12/04/2022]
Abstract
B lymphocyte stimulator (BLyS, also indicated as BAFF (B-cell activating factor) and CD257), and A Proliferation Inducing Ligand (APRIL, CD256) are two members of the TNF superfamily with a central role in B cell survival. Antibodies against these factors have potential therapeutic relevance in autoimmune inflammatory disorders with a proven pathogenic contribution of B cells, such as multiple sclerosis (MS). In the current study we performed a multi-parameter efficacy comparison of monoclonal antibodies against human anti-BLyS and anti-APRIL in a common marmoset (Callithrix jacchus) model of experimental autoimmune encephalomyelitis (EAE). A MS-like disease was induced by immunization with recombinant human myelin/oligodendrocyte glycoprotein (rhMOG) in complete Freund’s adjuvant. The results show that the anti-BLyS and anti-APRIL antibody cause significant depletion of circulating CD20+ B cells, but a small subset of CD20 + CD40high B cells was not depleted. Induction of CD20+ B cell depletion from lymph nodes was only observed in the anti-BLyS treated monkeys. Both antibodies had a significant inhibitory effect on disease development, but all monkeys developed clinically evident EAE. Anti-BLyS treated monkeys were sacrificed with the same clinical signs as saline-treated monkeys, but nevertheless displayed significantly reduced spinal cord demyelination. This effect was not observed in the anti-APRIL treated monkeys. The two antibodies had a different effect on T cell subset activation and the profiles of ex vivo released cytokines. In conclusion, treatment with anti-BLyS and anti-APRIL delays the development of neurological disease in a relevant preclinical model of MS. The two mAbs achieve this effect via different mechanisms.
Collapse
Affiliation(s)
- S Anwar Jagessar
- Department Immunobiology, Biomedical Primate Research Centre, PO Box 3306, 2280 GH, Rijswijk, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Kaga Y, Shoemaker WJ, Furusho M, Bryant M, Rosenbluth J, Pfeiffer SE, Oh L, Rasband M, Lappe-Siefke C, Yu K, Ornitz DM, Nave KA, Bansal R. Mice with conditional inactivation of fibroblast growth factor receptor-2 signaling in oligodendrocytes have normal myelin but display dramatic hyperactivity when combined with Cnp1 inactivation. J Neurosci 2006; 26:12339-50. [PMID: 17122059 PMCID: PMC6675428 DOI: 10.1523/jneurosci.3573-06.2006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fibroblast growth factor receptors (Fgfr) comprise a widely expressed family of developmental regulators implicated in oligodendrocyte (OL) maturation of the CNS. Fgfr2 is expressed by OLs in myelinated fiber tracks. In vitro, Fgfr2 is highly upregulated during OL terminal differentiation, and its activation leads to enhanced growth of OL processes and the formation of myelin-like membranes. To investigate the in vivo function of Fgfr2 signaling by myelinating glial cells, we inactivated the floxed Fgfr2 gene in mice that coexpress Cre recombinase (cre) as a knock-in gene into the OL-specific 2',3'-cyclic nucleotide phosphodiesterase (Cnp1) locus. Surprisingly, no obvious defects were detected in brain development of these conditional mutants, including the number of OLs, the onset and extent of myelination, the ultrastructure of myelin, and the expression level of myelin proteins. However, unexpectedly, a subset of these conditional Fgfr2 knock-out mice that are homozygous for cre and therefore are also Cnp1 null, displayed a dramatic hyperactive behavior starting at approximately 2 weeks of age. This hyperactivity was abolished by treatment with dopamine receptor antagonists or catecholamine biosynthesis inhibitors, suggesting that the symptoms involve a dysregulation of the dopaminergic system. Although the molecular mechanisms are presently unknown, this novel mouse model of hyperactivity demonstrates the potential involvement of OLs in neuropsychiatric disorders, as well as the nonpredictable role of genetic interactions in the behavioral phenotype of mice.
Collapse
MESH Headings
- 2',3'-Cyclic-Nucleotide Phosphodiesterases/deficiency
- 2',3'-Cyclic-Nucleotide Phosphodiesterases/metabolism
- 2',3'-Cyclic-Nucleotide Phosphodiesterases/physiology
- Animals
- Animals, Newborn
- Behavior, Animal
- Blotting, Western/methods
- Brain/cytology
- Cell Differentiation/genetics
- Dopamine Antagonists/pharmacology
- Dose-Response Relationship, Drug
- Fibroblast Growth Factor 2/deficiency
- Fibroblast Growth Factor 2/physiology
- Green Fluorescent Proteins/biosynthesis
- Green Fluorescent Proteins/genetics
- Hyperkinesis/genetics
- Hyperkinesis/physiopathology
- Immunohistochemistry/methods
- In Situ Hybridization/methods
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Microscopy, Electron, Transmission/methods
- Motor Activity/drug effects
- Motor Activity/physiology
- Myelin Basic Protein/metabolism
- Myelin Sheath/metabolism
- Myelin Sheath/ultrastructure
- Oligodendroglia/metabolism
- Oligodendroglia/ultrastructure
- Tyrosine 3-Monooxygenase/metabolism
Collapse
Affiliation(s)
- Y Kaga
- Department of Neuroscience, University of Connecticut Medical School, Farmington, Connecticut 06030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
One hundred patients scheduled for elective caesarean section under epidural anaesthesia were randomized to have epidural loading doses in either the horizontal or a 10 degrees head-up position. They were assigned to their position only after an initial dose of 4 ml of 0.5% bupivacaine had been given. Ten minutes after this dose they were given 10 ml of 0.5% bupivacaine and 50 microg of fentanyl in their allocated position. Pain during surgery was assessed by the patients using a visual analogue scale and by a blinded anaesthetist. Giving the main dose in the head-up tilt position reduced the incidence of intea-operative pain significantly. The median pain score for the head-up position was zero while the score was two for the horizontal position. The inter-quartile range was 0 to 2 for the head-up tilt position and 0 to 4 for the horizontal position (P<0.05). Position had no significant effect on the blood pressure or Bromage score. A 10 degrees head-up tilt position is useful during the establishment of epidural anaesthesia to reduce the pain experienced by the patient during caesarean section.
Collapse
Affiliation(s)
- Y K Chan
- Department of Anaesthesiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | |
Collapse
|
19
|
|