BAX 855, a PEGylated rFVIII product with prolonged half-life

A longer acting recombinant FVIII is expected to serve patients’ demand for a more convenient prophylactic therapy. We have developed BAX 855, a PEGylated form of Baxter’s rFVIII product ADVATE™ based on the ADVATE™ manufacturing process. The conjugation process for preparing BAX 855 uses a novel PEG reagent. The production process was adjusted to yield a rFVIII conjugate with a low PEGylation degree of about 2 moles PEG per FVIII molecule. This optimised modification degree resulted in an improved PK profile for rFVIII without compromising its specific activity. PEGylation sites were identified by employing various HPLC- and MS-based methods. These studies not only indicated that about 60% of the PEG chains are localised to the B-domain, which is cleaved off upon physiological activation during the coagulation process, but also demonstrated an excellent lot to lot consistency with regard to PEGylation site distribution. Detailed biochemical characterization further showed that PEGylated FVIII retained all the physiological functions of the FVIII molecule with the exception of binding to the LRP clearance receptor which was reduced for BAX 855 compared to ADVATE™. This might provide an explanation for the prolonged circulation time of BAX 855 as reduced receptor binding might slow-down clearance. Preclinical studies showed improved pharmacokinetic behaviour and clinically relevant prolonged efficacy compared to ADVATE™ without any signs of toxicity or elevated immunogenicity. The comprehensive preclinical data package formed the basis for approval of the phase 1 clinical study by European authorities which started in 2011.

A generic risk-based surveying method for invading plant pathogens

Invasive plant pathogens are increasing with international trade and travel, with damaging environmental and economic consequences. Recent examples include tree diseases such as sudden oak death in the Western United States and ash dieback in Europe. To control an invading pathogen it is crucial that newly infected sites are quickly detected so that measures can be implemented to control the epidemic. However, since sampling resources are often limited, not all locations can be inspected and locations must be prioritized for surveying. Existing approaches to achieve this are often species specific and rely on detailed data collection and parameterization, which is difficult, especially when new arrivals are unanticipated. Consequently regulatory sampling responses are often ad hoc and developed without due consideration of epidemiology, leading to the suboptimal deployment of expensive sampling resources. We introduce a flexible risk-based sampling method that is pathogen generic and enables available information to be utilized to develop epidemiologically informed sampling programs for virtually any biologically relevant plant pathogen. By targeting risk we aim to inform sampling schemes that identify high-impact locations that can be subsequently treated in order to reduce inoculum in the landscape. This "damage limitation" is often the initial management objective following the first discovery of a new invader. Risk at each location is determined by the product of the basic reproductive number (R0), as a measure of local epidemic size, and the probability of infection. We illustrate how the risk estimates can be used to prioritize a survey by weighting a random sample so that the highest-risk locations have the highest probability of selection. We demonstrate and test the method using a high-quality spatially and temporally resolved data set on Huanglongbing disease (HLB) in Florida, USA. We show that even when available epidemiological information is relatively minimal, the method has strong predictive value and can result in highly effective targeted surveying plans.

BAX 855, a PEGylated rFVIII product with prolonged half-life. Development, functional and structural characterisation

A longer acting recombinant FVIII is expected to serve patients' demand for a more convenient prophylactic therapy. We have developed BAX 855, a PEGylated form of Baxter's rFVIII product ADVATE™ based on the ADVATE™ manufacturing process. The conjugation process for preparing BAX 855 uses a novel PEG reagent. The production process was adjusted to yield a rFVIII conjugate with a low PEGylation degree of about 2 moles PEG per FVIII molecule. This optimised modification degree resulted in an improved PK profile for rFVIII without compromising its specific activity. PEGylation sites were identified by employing various HPLC- and MS-based methods. These studies not only indicated that about 60% of the PEG chains are localised to the B-domain, which is cleaved off upon physiological activation during the coagulation process, but also demonstrated an excellent lot to lot consistency with regard to PEGylation site distribution. Detailed biochemical characterization further showed that PEGylated FVIII retained all the physiological functions of the FVIII molecule with the exception of binding to the LRP clearance receptor which was reduced for BAX 855 compared to ADVATE™. This might provide an explanation for the prolonged circulation time of BAX 855 as reduced receptor binding might slow-down clearance. Preclinical studies showed improved pharmacokinetic behaviour and clinically relevant prolonged efficacy compared to ADVATE™ without any signs of toxicity or elevated immunogenicity. The comprehensive preclinical data package formed the basis for approval of the phase 1 clinical study by European authorities which started in 2011.

Prevalence of nasal methicillin-resistant Staphylococcus aureus colonization in healthcare workers in a Western Australian acute care hospital

Due to a longstanding comprehensive "search and destroy policy", methicillin-resistant Staphylococcus aureus (MRSA) is not endemic in Western Australian (WA) acute care hospitals. As the prevalence of MRSA in the community has increased, healthcare workers (HCW) are at risk of importing MRSA into hospitals. We aimed to determine the prevalence of and risk factors for nasal MRSA colonization in our HCW population. A period prevalence study was conducted at an 850-bed tertiary hospital. Basic demographics and a nasal swab were obtained. A total of 1,542 HCWs employed in our centre were screened for MRSA, of whom 3.4% (n = 52) were colonized. MRSA colonization was more common in patient care assistants (6.8%) and nurses (5.2%) than in allied health professionals (1.7%) and doctors (0.7%) (p < 0.01). Working in "high-risk" wards that cared for MRSA colonized/infected patients was the strongest risk factor for HCW MRSA colonization (p < 0.001). ST1-IV and ST78-IV (the most common community clones in the region) were the most frequently identified clones. In conclusion, MRSA colonization of HCWs occurs primarily in HCWs caring for patients colonized or infected with MRSA. Surveillance screening of HCWs should be regularly performed on wards with patients with high MRSA colonization prevalence to prevent further spread in the hospital.

Comparison of Assessment of Citrus Canker Foliar Symptoms by Experienced and Inexperienced Raters

Citrus canker (Xanthomonas citri subsp. citri) is destructive in many citrus production regions in tropical and subtropical parts of the world. Assessment of canker symptoms is required for diverse reasons, including monitoring epidemics, evaluating the efficacy of control strategies, and disease response in breeding material. The objectives were to compare the ability of experienced and inexperienced raters at assessing citrus canker, to identify factors that affect the quality of the assessment, to determine common sources of error, and to discern how error is related to actual disease magnitude. Two-hundred digital leaf images (0 to 37% area infected) were assessed once by 28 raters, five of whom were experienced plant pathologists (PPs), and 23 who had no experience in disease severity assessment (NPPs). True disease (lesion number [LN], % necrotic area [%N], and % chlorotic+necrotic area [%CN]) was measured using image analysis on a leaf-by-leaf basis, and each parameter was estimated by the 28 raters. LN was neither severely over- nor underestimated, while %N was greatly overestimated, with a lesser tendency to overestimate %CN over the true severity range of these two symptom types. A linear relationship existed between estimate of the disease and true disease for all measures of severity. Data were heteroscedastic and error was not constant with increasing true disease. Agreement between rater estimates and true disease was measured with Lin's concordance correlation coefficient (ρ_c). LN showed greatest agreement (ρ_c = 0.88 to 0.99), followed by %CN (ρ_c = 0.80 to 0.95) and %N (ρ_c = 0.19 to 0.84). Greater lesion number resulted in overestimation of area infected for both %N and %CN. Overestimation was particularly noticeable at low disease severities. There was a linear relationship between log variance and log true disease for LN (r² = 0.71), %N (r² = 0.85), and %CN (r² = 0.88), and raters tended to estimate disease above 10% to the nearest 5 or 10%. GLM analysis showed differences between PP and NPP groups in assessing disease. For LN, precision of assessment for both groups was similar (r² > 0.92 and 0.94, respectively), but for estimates of %N and %CN, the PPs were more precise (%N and %CN, r² = 0.61 and 0.73, respectively) compared to NPPs (%N and %CN, r² = 0.45 and 0.58, respectively). Absolute error for mean LN was low. The absolute error of %N and %CN showed overestimation to approximately 8% area infected. Above 8%, absolute error increased, but comprised both over- and underestimation. For %N and %CN, relative error was almost exclusively positive and dramatic at severity <8% (up to approximately 600%), but at severity >10% it was relatively small. Error in rater estimates of canker severity is ubiquitous. Understanding these sources of error will aid in the development of both appropriate training and relevant rating aids.

Evaporative Tunnel Cooling of Dairy Cows in the Southeast. I: Effect on Body Temperature and Respiration Rate

The techniques used to mitigate the effects of heat stress on lactating dairy cows are often overwhelmed in the southeastern United States, where elevated heat and humidity often persist for extended periods. A model free-stall barn located at the North Mississippi Branch Experiment Station in Holly Springs was used to evaluate the potential of tunnel ventilation with evaporative cooling to alleviate heat stress in lactating dairy cows. Two studies were conducted using 2 groups of 10 lactating Holsteins housed in the tunnel barn (inside) and 2 groups of matched herdmates housed in an adjacent covered free-stall barn (outside), which was cooled by fans and sprinklers during 2001 or by shade and fans alone in 2003. Peak daytime temperatures inside were 5.2 +/- 0.18 degrees C below that outside in 2001 and 3.1 +/- 0.20 degrees C lower in 2003. Although evaporative cooling increased humidity by 22%, cows housed in the tunnel barn received 84% less exposure to moderate heat stress (temperature-humidity index > 80) in both years. Cooling cows with evaporative tunnel ventilation reduced respiration rates by 15.5 +/- 0.56 breaths/min and rectal temperatures by 0.6 +/- 0.02 degrees C compared with shade and fans alone in 2003. Cooling cows with evaporative tunnel ventilation reduced respiration rates by 13.1 +/- 0.78 breaths/min and rectal temperatures by 0.4 +/- 0.03 degrees C compared with fans and sprinklers in 2001. Thus, tunnel ventilation cooling dramatically reduced the exposure to heat stress and improved the comfort of lactating dairy cows when compared with traditional cooling technologies under the conditions present in the southeastern United States.

Evaporative Tunnel Cooling of Dairy Cows in the Southeast. II: Impact on Lactation Performance

Heat stress has a dramatic impact on the dairy industry, reducing production and profitability throughout the southeastern United States. In many regions, management techniques can be used to mitigate the effects of heat stress, but available cooling technologies are often overwhelmed by the conditions of chronic heat stress present in southeastern United States. Although combining tunnel ventilation and evaporative cooling (evaporative tunnel cooling) seems to provide superior cooling for dairy cows, there is a dearth of reports on the impact of this technology on milk production. A model evaporative tunnel cooling facility in northern Mississippi was studied using 2 groups of 10 lactating Holstein cows housed in the tunnel barn and 2 groups of 10 matched herdmates housed in an adjacent naturally ventilated free-stall barn. Two 10-wk trials were performed in 2 yr beginning June 25, 2001, and May 26, 2003, in which cows housed outside were cooled by traditional fans and shade alone (2003) or with sprinklers (2001). In both years, the use of evaporative tunnel cooling decreased exposure to conditions of moderate heat stress by 84%. Cows cooled by evaporative tunnel ventilation increased feed intake by 12 and 11% over cows housed outside in 2001 and 2003, respectively. Evaporative tunnel cooling had no effect on milk composition, but increased milk yield over the 10-wk trial by 2.6 +/- 0.27 and 2.8 +/- 0.19 kg/cow per day in 2001 and 2003, respectively. In addition, somatic cell count was decreased 27 to 49% by evaporative tunnel cooling. Thus, under the range of environmental conditions present, evaporative tunnel cooling reliably reduced exposure to conditions of heat stress and improved milk production of lactating dairy cows during the summer season.

Spontaneous bacterial peritonitis and bacteremia due to Leuconostoc species in a patient with end-stage liver disease: a case report

This report describes a case of spontaneous bacterial peritonitis in a patient with end stage liver disease in whom Leuconostoc spp. was isolated from blood and ascitic fluid. In common with several previously described patients with cultures positive for Leuconostoc from other body sites, this patient had recently received vancomycin. The antibiotic susceptibilities and mechanism of vancomycin resistance of this Gram-positive bacteria are reviewed.

Characterisation of the aggregation behaviour in a salmeterol and fluticasone propionate inhalation aerosol system

The nature of the drug-drug aggregation phenomena between salmeterol xinafoate and fluticasone propionate used in a metered-dose inhaler system has been examined. Interactions between the drugs in the solvents 1,1,2-trichlorotrifloroethane (CFC-113) and 1,1,1,2-tetrafluoroethane (HFA-134a) have been characterised using a focused beam reflectance measurement probe by measuring the average floc size of the drug particles individually and in combination as a function of stirrer rate. The floc composition in the CFC-113 system, where the drug particles cream, was determined by high-performance liquid chromatography analysis. The aggregation behaviour of the individual drugs was shown to depend on the physical and chemical properties of both the drug substance and the media. Larger flocs were observed for salmeterol xinafoate compared with fluticasone propionate, while both drugs formed larger aggregates in HFA-134a compared with in CFC-113. The floc composition studies demonstrated that, in the combined formulation in CFC-113, salmeterol xinafoate and fluticasone propionate aggregate together to form hetero-flocs. The interaction between the two drugs was such that they did not separate on creaming, despite having different densities. The average floc size of the combined drug suspension was also found to depend on the dispersion medium.