The Safety and Antiviral Activity of BZF961 with or without Ritonavir in Patients Infected with Hepatitis C Virus: A Randomized, Multicenter Trial

PURPOSE

Infection with hepatitis C virus is the leading cause of infectious disease mortality in the United States. BZF961 is a novel small molecule inhibitor of the hepatitis C virus NS3-4A protease. Here we present the results of a randomized, double-blinded, placebo-controlled, multicentered study in treatment-naïve patients with chronic hepatitis C virus genotype-1 infection.

METHODS

Patients were enrolled sequentially in 2 parts and treated for 3days. BZF961 was administered as monotherapy (500mg BID for 3 days) or in combination with the cytochrome P450 3A4 inhibitor ritonavir to boost its exposure (BZF961 10, 20, or 50mg QD or BID).

FINDINGS

BZF961 was safe and well tolerated in the patients studied with no serious adverse events. There were no appreciable differences in adverse events among patients who received BZF961, BZF961 with ritonavir, or placebo. There was a significant, clinically meaningful reduction in viral load from baseline in patients treated either with BZF961 500mg every 12hours alone or BZF961 50mg every 12hours in combination with ritonavir. Activity against the hepatitis C virus of the lower-dose regimens was apparent but more modest. There were no relevant changes from baseline viral loads in placebo-treated patients.

IMPLICATIONS

Coadministration of ritonavir with BZF961 boosted BZF961 exposure (including C_min, which is the clinically relevant parameter associated with antiviral activity) in a therapeutic range with less variability compared with BZF961 alone. For strategic reasons, BZF961 is no longer under development.

The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation

The availability of direct-acting antiviral agents for the treatment of hepatitis C virus (HCV) infection has resulted in a profound shift in the approach to the management of this infection. These changes have affected the practice of solid organ transplantation by altering the framework by which patients with end-stage organ disease are managed and receive organ transplants. The high level of safety and efficacy of these medications in patients with chronic HCV infection provides the opportunity to explore their use in the setting of transplanting organs from HCV-viremic patients into non-HCV-viremic recipients. Because these organs are frequently discarded and typically come from younger donors, this approach has the potential to save lives on the solid organ transplant waitlist. Therefore, an urgent need exists for prospective research protocols that study the risk versus benefit of using organs for hepatitis C-infected donors. In response to this rapidly changing practice and the need for scientific study and consensus, the American Society of Transplantation convened a meeting of experts to review current data and develop the framework for the study of using HCV viremic organs in solid organ transplantation.

Pan-PIM kinase inhibition provides a novel therapy for treating hematologic cancers

PURPOSE

PIM kinases have been shown to act as oncogenes in mice, with each family member being able to drive progression of hematologic cancers. Consistent with this, we found that PIMs are highly expressed in human hematologic cancers and show that each isoform has a distinct expression pattern among disease subtypes. This suggests that inhibitors of all three PIMs would be effective in treating multiple hematologic malignancies.

EXPERIMENTAL DESIGN

Pan-PIM inhibitors have proven difficult to develop because PIM2 has a low Km for ATP and, thus, requires a very potent inhibitor to effectively block the kinase activity at the ATP levels in cells. We developed a potent and specific pan-PIM inhibitor, LGB321, which is active on PIM2 in the cellular context.

RESULTS

LGB321 is active on PIM2-dependent multiple myeloma cell lines, where it inhibits proliferation, mTOR-C1 signaling and phosphorylation of BAD. Broad cancer cell line profiling of LGB321 demonstrates limited activity in cell lines derived from solid tumors. In contrast, significant activity in cell lines derived from diverse hematological lineages was observed, including acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), multiple myeloma and non-Hodgkin lymphoma (NHL). Furthermore, we demonstrate LGB321 activity in the KG-1 AML xenograft model, in which modulation of pharmacodynamics markers is predictive of efficacy. Finally, we demonstrate that LGB321 synergizes with cytarabine in this model.

CONCLUSIONS

We have developed a potent and selective pan-PIM inhibitor with single-agent antiproliferative activity and show that it synergizes with cytarabine in an AML xenograft model. Our results strongly support the development of Pan-PIM inhibitors to treat hematologic malignancies.

Effects of diazepam and flumazenil on food competition behavior in high- and low-aggression pigeons

The food competition interaction test performed with food-restricted pigeons with previously consolidated dominance is a useful tool for the study of offensive and defensive social aggression. In the present study, we examined the effect of GABA-A-benzodiazepine (BZD) receptor manipulation on aggression, emotion, feeder control, and eating behavior in high- and low-aggression female pigeons maintained at 80% of their normal weight and exposed to food competition interactions. The pigeons were divided into pairs by previously ranked high-aggression females (total time spent in aggression over 60 s/5 min; n=6 pairs) and low-aggression females (time spent in aggression less than 10 s/5 min; n=6 pairs). In Experiment 1, a pigeon in each pair of high- and low-aggression subjects were treated daily with an oral dose of diazepam (DZP, 0.6 mg/kg/0.3 ml) for 8 days. The other animal received the vehicle. On Day 8, food competition trials (10 min) were performed 30 min after treatments. In Experiment 2, pigeons were injected subcutaneously with flumazenil (FZL, 0.1 mg/kg/1 ml) or saline and exposed to a food competition trial 30 min after injections. In Experiment 3, one animal in each pair received DZP for 8 days. The other animal received the vehicle. On Day 8, the DZP-treated subjects were injected subcutaneously with FZL (0.1 mg/ kg/1 ml) 30 min before the oral dose of DZP. Trials were performed 30 min after DZP or vehicle administration. In Experiment 1, it was found that the DZP group of high-aggression pigeons showed lower scores of aggression (P<.05) and emotional responses (P<.05) than controls. The other group-scored behaviors were not affected. The DZP low-aggressions, however, showed scores of aggression eightfold higher than their controls (P<.05) but the other scored behaviors were not changed. In Experiment 2, FZL injection did not induce intrinsic effects on aggression either in the high- or in the low-aggression group. Experiment 3 showed that the emotional and aggressive responses to DZP were neutralized by FZL. This shows that GABA-A-BZD receptor mechanisms are implicated in the DZP responses in high- and low-aggression pigeons.

[Autism:diagnosis criteria. Cognitive-evolutionary approach]

OBJECTIVE

To get acquainted with the information handled by health professionals regarding autism and its diagnosis criteria in the province of Mendoza, Argentina.

METHODOLOGY

Qualitative. A descriptive and exploratory study was conducted on a non-probabilistic sample of 38 professionals of Mendoza province. The professionals answered a questionnaire on autism and its diagnosis criteria.

RESULTS

Fifty-five percent of the professionals of the sample did not diagnose autism. The professionals that did (45percent of the sample), though updated as regards diagnosis criteria, did not handle actual information about origin and type of this pathology, its symptoms and characteristics. Since most professionals belong to public institutions of the province, these results become relevant.

Effect of the i.c.v. injection of 5,7-di-hydroxytryptamine on the aggressive behavior of dominant and submissive pigeons (Columba livia)

The acute and chronic treatment with 5-HTP was reported to block the aggressive reaction induced by food competition in undernourished dominant pigeons. Such treatment was not effective, however, in submissive pigeons. In this report we describe the effect of the neurotoxine 5, 7-DHT on aggression, defense, emotion, feeder control, and other behaviors in dominant and submissive male pigeons maintained at 80% of their normal weight. These were ranked through daily food competition trials. To obtain the prelesion scores dominant (n = 15) and submissive pigeons (n = 16) were submitted to a daily trial against a different intermediate subject (six trials). Then, the dominant and submissive groups were subcutaneously injected with Desipramine (25 micrograms/kg), anesthetized at a 60 min interval and injected with 5, 7-DHT into the left lateral ventricle (25 micrograms/25 microliters 0.9% NaCl). After a 30-day interval, both lesioned dominants and submissives were confronted to a different untreated intermediate subject over six daily sessions (postlesion scores). Differences between pre- and postlesion scores for all behavior studied were not found in dominant subjects. In submissive subjects, however, the postlesion scores of total aggression, defensive behavior, and emotional behavior were significantly higher than pre lesion scores. When brain 5-HT was assayed 60 days after injection about 34% depletion was found for both groups of pigeons. These findings suggest that the behavioral response to brain 5-HT denervation in pigeons is related to the behavioral characteristics of the subject previous to the lesion.

Effect of subchronic and chronic exposure to 5-hydroxytryptophan (5-HTP) on the aggressive behavior induced by food competition in undernourished dominant and submissive pigeons (Columba livia)

The acute administration of 5-HTP was reported to block in undernourished dominant pigeons the aggressive attacks induced in a submissive partner by food competition. In the present study, undernourished pigeons with previously consolidated dominance were submitted to subchronic and chronic 5-HTP treatment. Adult males (n = 28) were kept at 80% of their body weight by a restricted diet. These were divided in pairs made of a previously ranked dominant subject (total time spent in aggression higher than 200 s/20 min) and a submissive one of similar body weight (time spent in aggression between 90 and 150 s/20 min). The same pairs were exposed to a daily 20 min interaction during each experiment in an observation chamber bearing a central feeder. The time spent in aggressive behavior, feeder control behavior and eating behavior was recorded. Intratest body weight gain was also recorded. In Experiment 1, 8 pairs of pigeons were exposed to a daily trial for 4 successive days (pretreatment-scores). The dominant subjects were then injected subcutaneously, 30 min. before trials, with 7.5 mg/kg 5-HTP from day 5 to day 8 (Treatment scores). The Recovery scores were obtained through a 4-trial post-treatment schedule. In Experiment 2 different pigeons were used. The pretreatment and recovery scores were obtained according to a 16-trial schedule (16 days). Both 4-day (subchronic) and 16-day (chronic) 5-HTP treatments attenuated aggression by the dominant subjects and reduced their intra-test body weight gain but did not decrease dominance for feeder control. The recovery scores of total aggression in subchronic experiments returned to pretreatment scores. In chronic experiments, instead, the recovery scores of aggression remained lower than pretreatment scores, whereas body-weight-gain scores came back to pretreatment values. This suggests that dominant subjects submitted to chronic 5-HTP might have learned to maintain dominance and feeder control in a virtual absence of aggressive behavior.