Efficacy and safety of carfilzomib regimens in multiple myeloma patients relapsing after autologous stem cell transplant: ASPIRE and ENDEAVOR outcomes

Autologous stem cell transplantation (ASCT) is a standard treatment for eligible multiple myeloma (MM) patients, but many patients will relapse after ASCT and require subsequent therapy. The proteasome inhibitor carfilzomib is approved for relapsed or refractory MM (RRMM). In phase 3 trials, carfilzomib-based regimens (ASPIRE, carfilzomib-lenalidomide-dexamethasone; ENDEAVOR, carfilzomib-dexamethasone) demonstrated superior progression-free survival (PFS) compared with standard therapies for RRMM (ASPIRE: lenalidomide-dexamethasone; ENDEAVOR, bortezomib-dexamethasone). This subgroup analysis of ASPIRE and ENDEAVOR evaluated outcomes according to prior ASCT status. In total, 446 patients in ASPIRE and 538 in ENDEAVOR had prior ASCT. Median PFS was longer for carfilzomib-based regimens vs non-carfilzomib-based regimens for patients with prior ASCT (ASPIRE: 26.3 vs 17.8 months (hazard ratio (HR)=0.68); ENDEAVOR: not estimable vs 10.2 months (HR=0.61)), those with one prior line of therapy that included ASCT (ASPIRE: 29.7 vs 17.8 months (HR=0.70); ENDEAVOR: not estimable vs 11.2 months (HR=0.46)), and those without prior ASCT (ASPIRE: 26.4 vs 16.6 months (HR=0.76); ENDEAVOR: 17.7 vs 8.5 months (HR=0.43)). Overall response rates also favored the carfilzomib-based regimens. No new safety signals were detected. This analysis suggests that carfilzomib-based treatment may lead to improvement in PFS and response rates regardless of prior transplant status. Further evaluation is warranted.

Decreased myoblast differentiation in chronic binge alcohol-administered simian immunodeficiency virus-infected male macaques: role of decreased miR-206

Skeletal muscle stem cells play a critical role in regeneration of myofibers. We previously demonstrated that chronic binge alcohol (CBA) markedly attenuates myoblast differentiation potential and myogenic gene expression. Muscle-specific microRNAs (miRs) are implicated in regulation of myogenic genes. The aim of this study was to determine whether myoblasts isolated from asymptomatic CBA-administered simian immunodeficiency virus (SIV)-infected macaques treated with antiretroviral therapy (ART) showed similar impairments and, if so, to elucidate potential underlying mechanisms. Myoblasts were isolated from muscle at 11 mo after SIV infection from CBA/SIV macaques and from time-matched sucrose (SUC)-treated SIV-infected (SUC/SIV) animals and age-matched controls. Myoblast differentiation and myogenic gene expression were significantly decreased in myoblasts from SUC/SIV and CBA/SIV animals compared with controls. SIV and CBA decreased muscle-specific miR-206 in plasma and muscle and SIV decreased miR-206 expression in myoblasts, with no statistically significant changes in other muscle-specific miRs. These findings were associated with a significant increase in histone deacetylase 4 (HDAC4) and decrease in myogenic enhancer factor 2C (MEF2C) expression in CBA/SIV muscle. Transfection with miR-206 inhibitor decreased myotube differentiation, increased expression of HDAC4, and decreased MEF2C, suggesting a critical role of miR-206 in myogenesis. Moreover, HDAC4 was confirmed to be a direct miR-206 target. These results support a mechanistic role for decreased miR-206 in suppression of myoblast differentiation resulting from chronic alcohol and SIV infection. The parallel changes in skeletal muscle and circulating levels of miR-206 warrant studies to establish the possible use of plasma miR-206 as an indicator of impaired muscle function.

Inactivation of Cronobacter sakazakii in reconstituted infant formula by combination of thymoquinone and mild heat

AIMS

The objective of this study was to determine the combined effect of thymoquinone (TQ) and mild heat on Cronobacter sakazakii in reconstituted infant formula.

METHODS AND RESULTS

Reconstituted infant formula samples inoculated with a mixture of four C. sakazakii strains (approx. 6·5 log CFU ml(-1) ) were prepared with various concentrations of TQ (0, 5, 10, 20 and 30 mmol l(-1) ) and were heated to 45, 50 and 55°C for 0, 10, 20, 30, 60 and 120 min, and the surviving populations of C. sakazakii at each sampling time were enumerated. To elucidate the mode of action of TQ, membrane integrity and changes in cell morphology were examined by LIVE/DEAD(®) BacLight(™) bacterial viability kit and field emission scanning electron microscope respectively. TQ at 30 mmol l(-1) reduced the pathogen to undetectable level in between 60 and 120 min at 45°C, 60 min at 50°C and 10 min at 55°C respectively.

CONCLUSIONS

Our results demonstrated that the combined treatments significantly reduced (P < 0·05) the population of C. sakazakii, compared to the control. Cronobacter sakazakii numbers were reduced much more rapidly with higher temperatures and increased concentrations of TQ. And combined treatment inactivated pathogen partly by causing cell membrane disruption.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings suggested that TQ, together with mild heat, may have potential application in infant formula to control C. sakazakii before consumption and therefore is a possible way to prevent infections associated with C. sakazakii in infant formula.

Elevated serum complement C3 levels are related to the development of prediabetes in an adult population: the Tianjin Chronic Low-Grade Systematic Inflammation and Health Cohort Study

AIMS

To investigate whether serum complement C3 is related to the prevalence and incidence of prediabetes in an adult population.

METHODS

A cross-sectional (n = 10 206) and prospective cohort study (n = 3333), with a mean (range; 95% CI) follow-up of 2.63 (1-6; 2.58-2.68) years, was conducted in people recruited from the Health Management Centre of Tianjin Medical University General Hospital in Tianjin, China. Measurement of serum C3 concentration, blood fasting glucose, oral glucose tolerance, HbA1c and other potential confounding factors was performed at baseline and each year during the follow-up. Prediabetes was defined according to the criteria of the American Diabetes Association. Adjusted logistic and Cox proportional hazards regression models were used to assess the relationships between C3 quintiles and prediabetes.

RESULTS

The prevalence and incidence of prediabetes were 38.5% and 119 per 1000 person-years, respectively. In cross-sectional analysis, after adjustment for potential confounders, the odds ratios of prediabetes for increasing quintiles of C3 were 1.00 (reference), 1.32 (95% CI 1.14-1.53), 1.37 (95% CI 1.18-1.59), 1.75 (95% CI 1.51-2.03), 2.25 (95% CI 1.93-2.62; P for trend < 0.0001). In the cohort analysis, the multiple-adjusted hazard ratio of prediabetes in the highest quintile of baseline C3 was 1.43 (95% CI 1.15, 1.78; P for trend < 0.001), when compared with the lowest quintile.

CONCLUSIONS

These findings indicate that elevated serum C3 levels are significantly related to an increased risk of developing prediabetes in an adult population, suggesting that C3 can be used as a biomarker in high-risk individuals to improve primary prevention of prediabetes and diabetes.

A superhydrophilic nitinol shape memory alloy with enhanced anti-biofouling and anti-corrosion properties

This work reports on a nitinol (NiTi) surface modification scheme based on a chemical oxidation method, and characterizes its effects on wetting, biofouling and corrosion. The scheme developed is also compared with selected previous oxidation methods. The proposed method turns NiTi into superhydrophilic in ~5 min, and the static contact angle and contact angle hysteresis were measured to be ~7° and ~12°, respectively. In the PRP (platelet rich plasma) test, platelet adhesion was reduced by ~89% and ~77% respectively, compared with the original NiTi and the NiTi treated with the previous chemical oxidation scheme. The method developed provides a high (~1.1 V) breakdown voltage, which surpasses the ASTM standard for intervascular medical devices. It also provides higher superhydrophilicity, hemo-compatibility and anti-corrosion resistance than previous oxidation schemes, with a significantly reduced process time (~5 min), and will help the development of high performance NiTi devices.

Consumption of Chilies, but not Sweet Peppers, Is Positively Related to Handgrip Strength in an Adult Population

BACKGROUND

Chili consumption may have a beneficial effect on muscle strength in the general population. The aim of this study was to investigate the relationship between frequency of chili consumption and handgrip strength in adults.

DESIGN

Population-based cross-sectional study.

SETTING

This study used baseline data from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study.

PARTICIPANTS

A total of 3 717 subjects were recruited to the study. Frequency of chili consumption during the previous month was assessed using a valid self-administered food frequency questionnaire. Analysis of covariance was used to examine the relationship between muscle strength and frequency of chili consumption. Handgrip strength was measured using a handheld digital dynamometer.

RESULTS

After adjustment for potential confounding factors, significant relationships were observed between different categories of chili consumption and handgrip strength in males, the means (95% confidence interval) for handgrip strength across chili consumption categories were 44.7 (42.1, 47.2) for < one time/week; 45.5 (42.9, 48.1) for one time/week; and 45.8 (43.3, 48.4) for ≥ 2-3 times/week (P for trend < 0.01). Similar results were not observed with sweet pepper consumption.

CONCLUSIONS

This study reveals a positive correlation between frequency of chili consumption and muscle strength in adult males. Further studies are necessary in order to determine whether there is a causal relationship between chili consumption frequency and muscle strength.

Curved focal plane extreme ultraviolet detector array for a EUV camera on CHANG E lander

A novel curved focal plane extreme ultraviolet (EUV) detector array designed for a moon-based EUV camera is demonstrated. The curved focal plane detector array operating in a pulse-counting mode consists of a curved microchannel plate (MCP) stack and an induced charge wedge-strip anode (WSA). The curved MCP is fabricated by firstly thermally slumping of the MCPs, and then followed by optical polishing and core glass etching. By using this technology, curved MCPs with a length-to-diameter (L/D) ratio of 80:1 and a radius of curvature of 150 mm have been successfully achieved. The performance of the curved MCP detector is fully characterized in terms of the background noise, pulse height distribution, gain, image linearity and spatial resolution. It is measured that a spatial resolution of 7.13 lp/mm can be achieved with a background noise of less than 0.3 counts/cm2⋅s. The characterization results indicate that the curved focal plane detector can fulfill the requirements of the moon-based EUV camera.

Changes in cardiac function after pedicle subtraction osteotomy in patients with a kyphosis due to ankylosing spondylitis

Cardiac disease in patients with ankylosing spondylitis (AS) has previously been studied but not in patients with a kyphosis or in those who have undergone an operation to correct it.

The aim of this study was to measure the post-operative changes in cardiac function of patients with an AS kyphosis after pedicle subtraction osteotomy (PSO).

The original cohort consisted of 39 patients (33 men, six women). Of these, four patients (two men, two women) were lost to follow-up leaving 35 patients (31 men, four women) to study. The mean age of the remaining patients was 37.4 years (22.3 to 47.8) and their mean duration of AS was 17.0 years (4.6 to 26.4). Echocardiographic measurements, resting heart rate (RHR), physical function score (PFS), and full-length standing spinal radiographs were obtained before surgery and at the two-year follow-up.

The mean pre-operative RHR was 80.2 bpm (60.6 to 112.3) which dropped to a mean of 73.7 bpm (60.7 to 90.6) at the two-year follow-up (p = 0.0000). Of 15 patients with normal ventricular function pre-operatively, two developed mild left ventricular diastolic dysfunction (LVDD) at the two-year follow-up. Of 20 patients with mild LVDD pre-operatively only five had this post-operatively. Overall, 15 patients had normal LV diastolic function before their operation and 28 patients had normal LV function at the two-year follow-up.

The clinical improvement was 15 out of 20 (75.0%): cardiac function in patients with AS whose kyphosis was treated by PSO was significantly improved.

Cite this article: Bone Joint J 2015;97-B:1405–10.

Modified total arch replacement using a four-branched arch graft for acute type A aortic dissection with minimal brain and spinal cord ischemic time

AIM

This study aimed to evaluate the results of modified surgical strategies of total arch replacement using a four-branched arch graft, stented elephant trunk, and innovative organ protection method for acute type A aortic dissection.

METHODS

Between August 2011 and December 2011, 21 patients with acute type A aortic dissection underwent modified total arch replacement using the four-branched arch graft technique. All 21 patients had emergency surgery. Five patients had undergone previous aortic or cardiac surgery. The operations were stented elephant trunk implantation in 17 patients, ascending aorta replacement in 21 patients, coronary artery bypass grafting in four patients, Bentall operation in two patients, and aortic valve replacement in one patient. Twenty-one operations were performed under deep hypothermic extracorporeal circulation, modified selective cerebral perfusion, and end-organ and spinal cord protection for arch reconstruction.

RESULTS

There was two in-hospital deaths (9.5%). No persisting neurologic deficits or paraplegia occurred in 21 patients. Cardiopulmonary bypass time was 177.9±37.8 minutes. Myocardial ischemic time was 110.3±29.3 minutes. ICU time was 8.8±6.9 days and in-hospital duration was 28.7±13.7 days. Ventilation time varied from 9 hours to 21 days. A tracheotomy was necessary in four patients. Mean follow-up was 7.3±1.7 months and all patients are still alive.

CONCLUSION

Modified total arch replacement using a four-branched arch graft with stented elephant trunk and innovative organ protection is a useful and safe alternative technique for the treatment of acute type A aortic dissection and the results are encouraging.

A myeloablative conditioning regimen with fludarabine demonstrates good results in UCBT for 30 pediatric patients with hematologic malignancies, especially acute lymphoblastic leukemia

We retrospectively analyzed the safety and efficacy of a myeloablative conditioning regimen with fludarabine (FLU) in unrelated cord blood transplantation (UCBT) of 30 pediatric patients with hematologic malignancies. The conditioning regimen consisted of FLU, busulfan (BU) and cyclophosphamide (CY). All of the patients received Cyclosporine (CSA) and mycophenolate mofetil (MMF) as graft versus host disease (GVHD) prophylaxis. We achieved high engraftment rates (96.7%) and rapid hematopoietic reconstitution. Acute GVHD occurred in 12 cases of the 29 engraftment patients (41.4%), and 6 cases (20.7%) were of grade III-IV. Chronic GVHD only occurred in 1 of 28 evaluable patients (3.6%). Twenty-three patients (76.7%) became infected, and 3 cases (10.0%) died of severe infections. Cytomegalovirus (CMV) reactivation occurred in 70.0% of the patients, but no CMV diseases were observed, nor did any patients die of CMV infection. The cumulative incidence of relapse (6.7%) was significantly reduced, and none of the acute lymphoblastic leukemia (ALL) patients relapsed. The 3-year overall survival (OS) and event-free survival (EFS) rates were 73.3% and 70.0%, respectively. The 3-year OS and EFS of the ALL patients was 75.0%. This conditioning regimen demonstrates good results and security in UCBT, especially in acute lymphoblastic leukemia.

Dietary patterns are associated with prevalence of fatty liver disease in adults

BACKGROUND/OBJECTIVES

Previous studies have indicated that higher levels of food consumption are associated with fatty liver disease (FLD), but few studies have investigated the relationship between this disease and different dietary patterns. The aim of this cross-sectional study was to examine the association between dietary patterns and FLD in adults.

SUBJECTS/METHODS

Dietary intakes of participants in the Tianjin were assessed via questionnaire. Factor analysis was used to identify dietary patterns, and FLD was defined as having a FLD diagnosis using liver ultrasonography. Relationships between dietary patterns and FLD were assessed using multiple logistic regression analysis.

RESULTS

Female participants in the highest quartile of high-carbohydrate/sweet pattern scores had a 2.19-fold greater risk (95% confidence interval (CI), 1.40-3.46) of developing non-alcoholic FLD (NAFLD) than those in the lowest quartile after adjusting for confounding factors. No significant differences were found between any dietary pattern and NAFLD in males. In males, a significantly increasing trend of alcoholic FLD (AFLD) prevalence was associated with increasing high-protein/cholesterol pattern scores (P for trend = 0.03; odds ratio (OR), 2.08; 95% CI, 1.15-3.81) while an increased high-carbohydrate/sweet pattern score appeared protective against AFLD (P for trend = 0.02; OR, 0.55; 95% CI, 0.29-1.00).

CONCLUSIONS

Our study demonstrates that high-protein/cholesterol pattern scores are associated with higher prevalence of AFLD in males. We also show high-carbohydrate/sweet pattern scores are associated with higher prevalence of NAFLD in females; but, interestingly, this pattern shows a favorable effect on AFLD in males.

209 CLONED EMBRYONIC DEVELOPMENT AND GENE EXPRESSION OF SPONTANEOUSLY IMMORTALIZED PORCINE SKIN FIBROBLASTS

Immortalization of somatic cells by oncogenes is effective for evaluation of gene targeting tools or molecular cell pathway because of relatively longer life span than normal cells. The BMI1 gene has been used to immortalize human and murine somatic cells, and we confirmed that BMI1 increased cell-life span of porcine skin fibroblasts and had no detrimental effect on pre-implantational development after somatic-cell nuclear transfer (SCNT; unpublished data). Here, we report a primary cell-line which was spontaneously immortalized without transduction of any additional gene. The minipig skin fibroblasts (passage 3 after primary culture) were divided into two parts, one group was electroporetically transfected with pCAG-BMI1-T2A-RFP plasmids (BC1) and the other had no treatment (CC1). To establish the single-cell-originated cell-lines, cells of each group were plated in 100-mm dishes at 100 cells/dish and well-formed colonies were picked up after 2 weeks. These colonies were expanded until they were fully confluent in 100-mm dishes (designated Passage 0) and then, the cell were maintained with DMEM (20% FBS) at 3 × 105 cells/60 mm dish. Population doubling time was checked every 5 passages until Passage 45 (sub-cultured during ~160 days) by calculation of cells that had been plated in 12-well plates at 4 × 104 cells/well. The expressions of p16, p21, and DNMT3b genes were determined by RT-qPCR at early (Passage 5) and late (Passage 45) stage. Also, SCNT (Song et al. 2009 Mol. Reprod. Dev. 76, 611–619) embryos using cells of early and middle (Passage 35) stage were evaluated in terms of reprograming efficiency. Data were analysed by t-test (Prism version 5.01, GraphPad Software, La Jolla, CA, USA). While the mean doubling time of BC1 was 25.3 h until Passage 40 and drastically increased at Passage 45 (81.7 h), that of CC1 was maintained until Passage 45 (mean 38.3 h). Expression of p16 in CC1 was significantly higher than that in BC1 at all stages. However, in late stage CC1, p21 expression was significantly lower than other groups and DNMT3b expression was increased. In SCNT embryos, the rate of blastocysts with early stage CC1 (18.3%) was not different from that of early stage BC1 (19.9%). And, although the rates of SCNT blastocyst derived from middle stage cells were decreased than those of early stage cells, there was no difference between BC1 and CC1 (6.6% and 5.4%, respectively). In karyotyping, while BC1 was trisomy of chromosome 14 only in late stage, CC1 had an isochromosome in chromosome 17 from early stage and an additional part was attached in chromosome 11 at late stage CC1. In summary, spontaneously immortalized skin fibroblasts could maintain the cell-life span by down-regulating the p21 expression and the pre-implantational development after SCNT was not different from that of BMI1-immortalized cells. And, additional studies are needed to confirm whether the chromosomal abnormality influences the expression of other genes related with cell cycle or senescence.This study was supported by NRF-2013R1A1A2010766, IPET (#311011-05-3-SB010), the Research Institute for Veterinary Science, and the BK21 plus program.

Overexpression of the Brassica rapa transcription factor WRKY12 results in reduced soft rot symptoms caused by Pectobacterium carotovorum in Arabidopsis and Chinese cabbage

Chinese cabbage (Brassica rapa L. ssp. pekinensis), an important vegetable crop, can succumb to diseases such as bacterial soft rot, resulting in significant loss of crop productivity and quality. Pectobacterium carotovorum ssp. carotovorum (Pcc) causes soft rot disease in various plants, including Chinese cabbage. To overcome crop loss caused by bacterial soft rot, a gene from Chinese cabbage was isolated and characterised in this study. We isolated the BrWRKY12 gene from Chinese cabbage, which is a group II member of the WRKY transcription factor superfamily. The 645-bp coding sequence of BrWRKY12 translates to a protein with a molecular mass of approximately 24.4 kDa, and BrWRKY12 was exclusively localised in the nucleus. Transcripts of BrWRKY12 were induced by Pcc infection in Brassica. Heterologous expression of BrWRKY12 resulted in reduced susceptibility to Pcc but not to Pseudomonas syringae pv. tomato in Arabidopsis. Defence-associated genes, such as AtPDF1.2 and AtPGIP2, were constitutively expressed in transgenic lines overexpressing BrWRKY12. The expression of AtWKRY12, which is the closest orthologue of BrWRKY12, was down-regulated by Pcc in Arabidopsis. However, the Atwrky12-2 mutants did not show any difference in response to Pcc, pointing to a difference in function of WRKY12 in Brassica and Arabidopsis. Furthermore, BrWRKY12 in Chinese cabbage also exhibited enhanced resistance to bacterial soft rot and increased the expression of defence-associated genes. In summary, BrWRKY12 confers enhanced resistance to Pcc through transcriptional activation of defence-related genes.

Andrographolide inhibits HMGB1-induced inflammatory responses in human umbilical vein endothelial cells and in murine polymicrobial sepsis

AIM

Nuclear DNA-binding protein high-mobility group box 1 (HMGB1) protein acts as a late mediator of severe vascular inflammatory conditions, such as septic shock, upregulating pro-inflammatory cytokines. Andrographolide (AG) is isolated from the plant of Andrographis paniculata and used as a folk medicine for treatment of viral infection, diarrhoea, dysentery and fever. However, the effect of AG on HMGB1-induced inflammatory response has not been studied.

METHODS

Firstly, we accessed this question by monitoring the effects of post-treatment AG on lipopolysaccharide (LPS) and caecal ligation and puncture (CLP)-mediated release of HMGB1 and HMGB1-mediated regulation of pro-inflammatory responses in human umbilical vein endothelial cells (HUVECs) and septic mice.

RESULTS

Post-treatment AG was found to suppress LPS-mediated release of HMGB1 and HMGB1-mediated cytoskeletal rearrangements. AG also inhibited HMGB1-mediated hyperpermeability and leucocyte migration in septic mice. In addition, AG inhibited production of tumour necrosis factor-α (TNF-α) and activation of AKT, nuclear factor-κB (NF-κB) and extracellular-regulated kinases (ERK) 1/2 by HMGB1 in HUVECs. AG also induced downregulation of CLP-induced release of HMGB1, production of interleukin (IL) 1β/6/8 and mortality.

CONCLUSION

Collectively, these results suggest that AG may be regarded as a candidate therapeutic agent for the treatment of vascular inflammatory diseases via inhibition of the HMGB1 signalling pathway.

Reduced STMN1 expression induced by RNA interference inhibits the bioactivity of pancreatic cancer cell line Panc-1

Increased expression of STMN1 has been observed in many tumor forms, but its expression and potential biological role in pancreatic cancer is still unknown. In this study, we demonstrated that STMN1 was expressed to a large extent in pancreatic cancer tissues and cell lines as compared to normal pancreatic tissues. Suppression of STMN1 expression via transfection with STMN1-specific siRNA could not only significantly inhibit the proliferation, migration and invasion ability of Panc-1 cells, but also enhance the apoptosis of Panc-1 cells. In addition, downregulation of STMN1 obviously enhanced the acetylation level of α-tubulin. All these results indicated that STMN1 plays an important role in pancreatic cancer development, and might serve as a potential therapeutic target for pancreatic cancer.

European non-invasive trisomy evaluation (EU-NITE) study: a multicenter prospective cohort study for non-invasive fetal trisomy 21 testing

OBJECTIVE

To evaluate the performance of a directed non-invasive prenatal testing method of cell-free DNA analysis for fetal trisomy 21 (T21) by shipping the whole blood samples from Europe to a laboratory in the USA.

METHODS

A European multicenter prospective, consecutive cohort study was performed enrolling pregnant women from Sweden and the Netherlands. Blood samples were drawn just prior to a planned of invasive diagnostic procedure in a population at increased risk for fetal T21 and then shipped to the USA without any blood processing. Chromosome-selective sequencing was carried out on chromosome 21 with reporting high risk or low risk of T21. Karyotyping or rapid aneuploidy detection was used as the clinical reference standard.

RESULTS

Of the 520 eligible study subjects, a T21 test result was obtained in 504/520 (96.9%). Risk assessment was accurate in 503/504 subjects (99.8%). There was one false negative result for T21 (sensitivity 17/18, 94.4%, and specificity 100%).

CONCLUSION

This is the first prospective European multicenter study showing that non-invasive prenatal testing using directed sequencing of cell-free DNA applied to blood samples shipped across the Atlantic Ocean, is highly accurate for assessing risk of fetal T21.