Standardization of allergen products: 2. Detailed characterization of GMP-produced recombinant Phl p 5.0109 as European Pharmacopoeia reference standard

BACKGROUND

The Biological Standardization Programme of the European Directorate for Quality of Medicines and Healthcare (EDQM) aims at the establishment of well-characterized reference standards based on recombinant allergens and validated assays for the quantification of major allergen content. The objective of this study was to examine the detailed physicochemical and immunological characterization of recombinant Phl p 5.0109, the second available allergen reference standard.

METHODS

Recombinant Phl p 5.0109 PP5ar06007 was produced under GMP conditions and analyzed by an array of physicochemical and immunological methods for identity, quantity, homogeneity, and folding stability in bulk solution, as well as thermal denaturation, aggregation state, and biological activity when formulated for long-time storage.

RESULTS

PP5ar06007 revealed as a highly homogeneous, monomeric, well-folded preparation of rPhl p 5.0109, as documented by mass spectrometry, SDS-PAGE, isoelectric focusing, size-exclusion chromatography with light scattering, circular dichroism, and infrared spectroscopy. Upon storage at +4°C, PP5ar06007 retained the monomeric state for at least 2 months. A protein quantity of 1.56 ± 0.03 mg/ml was determined by amino acid analysis in PP5ar06007, and its biological activity was shown to be comparable to natural Phl p 5 in terms of basophil activation and T-cell reactivity.

CONCLUSIONS

Recombinant Phl p 5.0109 PP5ar06007 was characterized extensively at the physicochemical and immunological level. It revealed to be a highly stable, monomeric, and immunologically equivalent of its natural counterpart. PP5ar06007 is now available as European Pharmacopoeia allergen reference standard for grass pollen products.

[Accidents and injuries in the EU. Results of the EuroSafe Reports]

BACKGROUND

Accidents and injuries are a relevant although largely preventable public health problem. Information on the causes of accidents is the basis for accident prevention and product safety. The current report "Injuries in the European Union", edited by EuroSafe, the European Association for Injury Prevention and Safety Promotion, is a summary of key statistics on accidents and injuries at the EU level. In addition to international data on cause of death, the data of the European Injury Data Base (IDB) in particular are presented.

METHODS

The IDB is a unique data source for the EU based on an internationally standardized dataset of external causes and circumstances of injuries, which is collected in the emergency department of hospitals. Thus, the IDB covers the entire spectrum of accidents and injuries in sufficient detail as is necessary for the derivation of preventive measures and the knowledge of involved products. The currently available IDB data are collected by the participating Member States (2012: Austria, Cyprus, Denmark, Germany, Italy, Latvia, Malta, The Netherlands, Norway, Portugal, Slovenia, and Sweden) in self-interest (i.e., without legal obligation) with the support of the EU health programs. The central database for the IDB is run by the European Commission and provides public access to the aggregated data of the participating countries. Currently, over 100 IDB hospitals in the EU upload around 300,000 cases per year into the EU database. The IDB contains information on all accident sectors (transport, workplace, school etc.) with a focus on leisure and sports accidents. Depending on the accident sector, up to 25 variables (activities, products involved, means of transport etc.) and often also short narratives are recorded for each case.

RESULTS

The report shows that 40 million people are treated in a hospital annually in the EU after accidents and violence, and that about 233,000 people die as a consequence of injury. There are large differences between countries in the rates of fatal and nonfatal injuries; these differences can be interpreted as a measure of the potential for prevention and as an indication of targeted measures in the countries with higher accident rates. The report also includes snapshots of the eight priority themes for injury prevention, as defined in the Recommendation of the European Council on Injury Prevention and Safety Promotion in 2007: children, adolescents and older people, vulnerable road users, sports, the use of products and services, violence, and self-injury.

DISCUSSION

The implementation of the IDB has proven to be feasible and useful for the participating countries, especially for data-based accident prevention in the important areas of home, leisure, and sports accidents. In the framework of the EU project JAMIE (2011-2014, Joint Action for Injury Monitoring in Europe), the IDB partners are currently working on further improving the IDB standards and quality criteria as well as the recruitment of further IDB countries. The medium-term goal is to integrate the EU IDB in the Eurostat Statistical System and to put the collection of IDB data on a statutory footing.

Maternal depression is associated with DNA methylation changes in cord blood T lymphocytes and adult hippocampi

Depression affects 10-15% of pregnant women and has been associated with preterm delivery and later developmental, behavioural and learning disabilities. We tested the hypothesis that maternal depression is associated with DNA methylation alterations in maternal T lymphocytes, neonatal cord blood T lymphocytes and adult offspring hippocampi. Genome-wide DNA methylation of CD3+ T lymphocytes isolated from 38 antepartum maternal and 44 neonatal cord blood samples were analyzed using Illumina Methylation 450 K microarrays. Previously obtained methylation data sets using methylated DNA immunoprecipitation and array-hybridization of 62 postmortem hippocampal samples of adult males were re-analyzed to test associations with history of maternal depression. We found 145 (false discovery rate (FDR) q<0.05) and 2520 (FDR q<0.1) differentially methylated CG-sites in cord blood T lymphocytes of neonates from the maternal depression group as compared with the control group. However, no significant DNA methylation differences were detected in the antepartum maternal T lymphocytes of our preliminary data set. We also detected 294 differentially methylated probes (FDR q<0.1) in hippocampal samples associated with history of maternal depression. We observed a significant overlap (P=0.002) of 33 genes with changes in DNA methylation in T lymphocytes of neonates and brains of adult offspring. Many of these genes are involved in immune system functions. Our results show that DNA methylation changes in offspring associated with maternal depression are detectable at birth in the immune system and persist to adulthood in the brain. This is consistent with the hypothesis that system-wide epigenetic changes are involved in life-long responses to maternal depression in the offspring.

Direct photonic coupling of a semiconductor quantum dot and a trapped ion

Coupling individual quantum systems lies at the heart of building scalable quantum networks. Here, we report the first direct photonic coupling between a semiconductor quantum dot and a trapped ion and we demonstrate that single photons generated by a quantum dot controllably change the internal state of a Yb^{+} ion. We ameliorate the effect of the 60-fold mismatch of the radiative linewidths with coherent photon generation and a high-finesse fiber-based optical cavity enhancing the coupling between the single photon and the ion. The transfer of information presented here via the classical correlations between the σ_{z} projection of the quantum-dot spin and the internal state of the ion provides a promising step towards quantum-state transfer in a hybrid photonic network.

Maternal childhood adversity and child temperament: an association moderated by child 5-HTTLPR genotype

We examined transgenerational effects of maternal childhood adversity on child temperament and a functional promoter polymorphism, 5-HTTLPR, in the serotonin-transporter gene (SLC6A4) as potential moderators of such maternal influences in 154 mother-child dyads, recruited into a longitudinal birth cohort study. We examined the interactive effects of maternal childhood experience using an integrated measure derived from Childhood Trauma Questionnaire (CTQ) and Parental Bonding Index (PBI). Triallelic genotyping of 5-HTTLPR was performed. A measure of 'negative emotionality/behavioural dysregulation' was derived from the Early Childhood Behaviour Questionnaire at 18 and 36 months. Negative emotionality/behavioural dysregulation was highly stable between 18 and 36 months and predicted psychosocial problems at 60 months. After controlling multiple demographics as well as both previous and concurrent maternal depression there was a significant interaction effect of maternal childhood adversity and offspring 5-HTTLPR genotype on child negative emotionality/behavioural dysregulation (β = 1.03, t(11,115) = 2.71, P < .01). The results suggest a transgenerational effect of maternal developmental history on emotional function in the offspring, describing a pathway that likely contributes to the familial transmission of vulnerability for psychopathology.

[KidsETransplant--a serious game for children with liver disease or liver transplant]

In Switzerland all children's liver transplants are centralized at the University Hospitals of Geneva (HUG) since 1989. Approximately 150 children have received transplants since then, and their survival rate is higher than 90%--one of the highest in Europe. Maximizing the chances of long-term success requires that patients comply with follow-up treatment, something which mandates a sound understanding of their medical condition. The KidsETransplant project aims to help the child--and his family--to understand better his state of health. To this end, our tool offers secured, unrestricted access to the patient's medical record, with a view to both increase patient autonomy and improve communication with healthcare professionals. This paper describes KidsETransplant, as well as its implemented evaluation process.

Size and polydispersity trends found in gold nanoparticles synthesized by laser ablation in liquids

In this work, we compare our experimental results with the latest computational findings for the synthesis of nanoparticles via Laser Ablation in Liquids (LAL). In addition, we demonstrate the usefulness of shadowgraphy imaging of the cavitation bubble in determination of ablation thresholds and irradiation efficiency.

Photon emission and absorption of a single ion coupled to an optical-fiber cavity

We present a light-matter interface which consists of a single 174Yb+ ion coupled to an optical fiber cavity. We observe that photons at 935 nm are mainly emitted into the cavity mode and that correlations between the polarization of the photon and the spin state of the ion are preserved despite the intrinsic coupling into a single-mode fiber. Complementary, when a faint coherent light field is injected into the cavity mode, we find enhanced and polarization dependent absorption by the ion.

The effects of femoral external derotational osteotomy on frontal plane alignment

PURPOSE

Femoral osteotomies are the preferred treatment in significant torsional deformity of the femur. The influence of torsional osteotomies on frontal plane alignment is poorly understood. Therefore, the aim of the present study was to evaluate the effects of external derotational osteotomies on proximal, mid-shaft and distal levels onto frontal plane alignment.

METHODS

The effect of rotation around the anatomical axis of the femur on frontal plane alignment was determined with a 3D computer model, created from CT data of a right human cadaver femur. Virtual torsional osteotomies of 10°, 20° and 30° were performed at proximal, mid-shaft and distal levels under five antecurvatum angles of the femur. The change of the frontal plane alignment was expressed by the mechanical lateral femoral angle.

RESULTS

Proximal derotational osteotomies resulted in an increased mechanical lateral distal femoral angle (mLDFA) of 0.8°-2.6° for 10°, of 1.6°-5.1° for 20° and of 2.3-7.9° for 30° derotational osteotomy, indicating an increased varus angulation. Supracondylar derotational osteotomy resulted in a decreased mLDFA of -0.1° to -1.7° for 10°, of -0.2 to -3.7° for 20° and of -0.7 to -6.9° for 30° derotational osteotomy, indicating an increased valgus angulation. The effect increased with the amount of torsional correction and virtually increased antecurvatum angles. Mid-shaft torsional osteotomies had the smallest effect on frontal plane alignment.

CONCLUSION

This three-dimensional computer model study demonstrates the relationship between femoral torsional osteotomies and frontal plane alignment. Proximal external derotational osteotomies tend to result in an increased varus angulation, whilst distal external derotational osteotomies tend to result in an increased valgus angulation. As a clinical consequence, torsional osteotomies have an increased risk of unintentional implications on frontal plane alignment.

Allergen hybrids - next generation vaccines for Fagales pollen immunotherapy

Background

Trees belonging to the order of Fagales show a distinct geographical distribution. While alder and birch are endemic in the temperate zones of the Northern Hemisphere, hazel, hornbeam and oak prefer a warmer climate. However, specific immunotherapy of Fagales pollen-allergic patients is mainly performed using birch pollen extracts, thus limiting the success of this intervention in birch-free areas.

Objectives

T cells are considered key players in the modification of an allergic immune response during specific immunotherapy (SIT), therefore we thought to combine linear T cell epitope-containing stretches of the five most important Fagales allergens from birch, hazel, alder, oak and hornbeam resulting in a Fagales pollen hybrid (FPH) molecule applicable for SIT.

Methods

A Fagales pollen hybrid was generated by PCR-based recombination of low IgE-binding allergen epitopes. Moreover, a structural-variant FPH4 was calculated by in silico mutagenesis, rendering the protein unable to adopt the Bet v 1-like fold. Both molecules were produced in Escherichia coli, characterized physico-chemically as well as immunologically, and tested in mouse models of allergic sensitization as well as allergy prophylaxis.

Results

Using spectroscopic analyses, both proteins were monomeric, and the secondary structure elements of FPH resemble the ones typical for Bet v 1-like proteins, whereas FPH4 showed increased amounts of unordered structure. Both molecules displayed reduced binding capacities of Bet v 1-specific IgE antibodies. However, in a mouse model, the proteins were able to induce high IgG titres cross-reactive with all parental allergens. Moreover, prophylactic treatment with the hybrid proteins prevented pollen extract-induced allergic lung inflammation in vivo.

Conclusion

The hybrid molecules showed a more efficient uptake and processing by dendritic cells resulting in a modified T cell response. The proteins had a lower IgE-binding capacity compared with the parental allergens, thus the high safety profile and increased efficacy emphasize clinical application for the treatment of Fagales multi-sensitization.

Intravenous sildenafil i.v. as rescue treatment for refractory pulmonary hypertension in extremely preterm infants

BACKGROUND

Intravenous sildenafil treatment has recently shown promising results and good tolerability in the treatment of refractory pulmonary hypertension (PH) in term and near-term neonates, while comparable data in preterm infants are still lacking. However, for critically ill preterm infants suffering from PH refractory to conventional treatment, sildenafil may represent a last treatment resort.

PATIENTS AND METHODS

We reviewed the records of 6 critically ill extremely preterm infants who had suffered from PH refractory to conventional treatment and had obtained intravenous sildenafil after careful consideration as ultima ratio treatment.

AIM

To describe the responses to sildenafil in terms of hemodynamic and respiratory changes during treatment and outcome.

RESULTS

4/6 patients showed resolution of severe PH with full reversal of ductal shunt direction into pure left-to-right shunt within 82 ± 35 h after sildenafil start. Remarkably, 2/6 patients developed pulmonary hemorrhage at a time point when significant improvement of PH had already taken place, both of them survived. Overall 4/6 patients died, two deaths were related to treatment-refractory PH.

CONCLUSION

Intravenous sildenafil treatment seems effective in improving severe PH and hemodynamic instability in extremely preterm infants with refractory PH. Pulmonary hemorrhage may represent a distinct adverse effect of sildenafil treatment in these patients, presumably due to sudden reversal of ductal shunt. Accordingly, sildenafil should be restricted to most severe and refractory cases in this population.

High fluoride and low calcium levels in drinking water is associated with low bone mass, reduced bone quality and fragility fractures in sheep

Chronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass.

INTRODUCTION

Understanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures.

METHODS

Dorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy.

RESULTS

The fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure.

CONCLUSIONS

Our data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone mass and (ii) can cause fragility fractures and (iii) that the prevalence of skeletal fluorosis especially due to groundwater exposure should be reviewed in many areas of the world as low bone mass alone does not exclude fluorosis.