Resistance characterization of ledipasvir and velpatasvir in hepatitis C virus genotype 4

HCV genotype 4 (GT4) has often been overlooked in drug development, even though it infects ~20 million people worldwide. Ledipasvir/sofosbuvir and sofosbuvir/velpatasvir were highly efficacious in GT4 HCV-infected patients from GS-US-337-1119 and GS-US-342-1138. Here, we characterize the resistance profile of ledipasvir (LDV) and velpatasvir (VEL) in patients with GT4 HCV infection. NS5A deep-sequencing was performed for 454 patients infected with HCV GT4 at baseline, including 44 patients enrolled in GS-US-337-1119 and 116 patients enrolled in GS-US-342-1138, and at relapse for patients with virologic failure. LDV and VEL susceptibilities of 56 patient isolates were determined. In GS-US-337-1119, SVR12 rates were 100% for all subtypes except 4b and 4r. Phenotypic assessment of 56 HCV NS5A patient isolates from various GT4 subtypes indicated that LDV had high potency for the common subtypes 4a/d, and subtypes 4c/f/k/l/m/n/o/p/r/t despite the presence of resistance-associated substitutions (RASs). For the rare GT4b, LDV median EC₅₀ was higher, but with a broad range of individual values. Importantly, all GT4b isolates tested had 2-4 NS5A RASs, some including Y93H. Similarly, the 2 GT4r infected patients who had virologic relapse had rare triple RASs. Reversion of these substitutions to the consensus residue significantly increased LDV susceptibility. In GS-US-342-1138, all patients achieved SVR12, regardless of their subtype or presence of RASs. In vitro data confirmed that VEL is potent against all GT4 isolates tested. LDV and VEL are potent antiviral drugs, estimated to be effective against >95% and >99%, respectively, of GT4 HCV isolates.

Auswirkungen der Länge der Trockenstehzeit bei Milchkühen auf Leistung, Gesundheit, Fruchtbarkeit und Kolostrumqualität

In Bezug auf die Milchproduktion ist die Trockenperiode eine unproduktive Zeit. Ferner steigt das Mastitisrisiko, wenn Kühe mit einer Tagesmilchleistung > 12,5 kg trockengestellt werden, was bei Trockenstehzeiten (TZ) von 55–60 Tagen häufig der Fall ist. Hinweise auf positive Auswirkungen einer verkürzten TZ auch auf die Stoffwechselgesundheit zu Beginn der Laktation und das Reproduktionsgeschehen waren der Anlass für diese Übersichtsarbeit. Durch Verzicht auf eine TZ oder deren Verkürzung sinkt die Milchleistung (ML) in der Folgelaktation, besonders ausgeprägt zu Beginn der zweiten Laktation. Es wird angenommen, dass dies unter anderem auf unterschiedlichen Involutions- und Proliferationsprozessen der Milchdrüsen primi- und multiparer Tiere beruht. Die Mehrzahl der Untersuchungsergebnisse spricht dafür, dass eine TZ-Verkürzung die Eutergesundheit nicht negativ, sondern eher positiv beeinflusst. Auch die Kolostrumqualität wird nicht beeinträchtigt. Bei Verzicht auf ein Trockenstellen kommt es lediglich zu einem Verdünnungseffekt. Nach einem Teil der Untersuchungen wird durch Verkürzung der TZ oder einen Verzicht darauf der Energiestoffwechsel zu Beginn der Laktation entlastet. Die eindeutig positiven Auswirkungen zeigten sich jedoch nur für multipare Tiere. Zudem werden die Ergebnisse durch weitere Faktoren (z. B. Melkfrequenz vor und nach dem Kalben) beeinflusst. In verschiedenen Studien wurden positive Auswirkungen einer Verkürzung der TZ auf das Reproduktionsgeschehen nachgewiesen. Die Zeit von der Kalbung bis zur ersten Ovulation wie auch Indikatoren zur Beurteilung des Besamungserfolgs und der Reproduktionsleistung zeigten bei Tieren ohne oder mit verkürzter TZ die besseren Ergebnisse, wobei auch diese vor allem für multipare Kühe zutrafen, während sich für primipare Tiere zum Teil sogar Verschlechterungen ergaben. Insgesamt ist festzustellen, dass sich die Frage nach einer optimalen Länge der TZ nicht allgemeingültig beantworten lässt. Die Festlegung der TZ sollte als betriebsspezifisch und bedarfsorientiert anzuwendendes Managementwerkzeug genutzt werden.

Verlauf einer Herdeninfektion mit BVDV-2

Gegenstand und Ziel: In der Fallstudie werden die klinischen Erkrankungen einer schweren akuten BVDV-2-Infektion mit hohen wirtschaftlichen Verlusten in einer Milchviehherde beschrieben und der Infektionsverlauf labordiagnostisch nachvollzogen. Material und Methoden: In dem Betrieb wurden 25 Kühe plus Nachzucht der Rasse Deutsch Fleckvieh gehalten. Der Betrieb war BHV-1-frei, die durchschnittliche Jahresmilchleistung pro Kuh lag bei 6500 kg. Erkrankungen und Befunde von September 2002 bis April 2003 wurden erfasst und ausgewertet. Der Nachweis von BVDVAntikörpern erfolgte mittels indirektem Antikörper-ELISA. BVDV-Antigene wurden mittels Antigen-ELISA und in der Immunfluoreszenz-Durchflusszytometrie nachgewiesen. Die Zuordnung der isolierten Viren zu BVDV-2 erfolgte mithilfe eines monoklonalen Antikörpers sowie der PCR. Ergebnisse: Sechs Kühe und eine Kalbin erkrankten an hämorrhagischen Enteritiden. Zwei dieser Kühe mussten euthanasiert werden, eine Kuh verendete. Sechs Tiere abortierten oder hatten eine Frühgeburt. Vier Kälber starben und drei lebensschwach geborene oder in den ersten Lebenswochen an profusem Durchfall erkrankte Kälber mussten euthanasiert werden. Zwei Kälber wurden persistent infiziert. Als Ursache der Erkrankungen wurde eine Bestandsinfektion mit BVDV-2 diagnostiziert. Schlussfolgerung und klinische Relevanz: Die Ergebnisse weisen darauf hin, dass die Herde zum Zeitpunkt der Bestandsinfektion BVDV-naiv war. Das Virus muss auch ohne die Anwesenheit eines persistent infizierten Tieres über längere Zeit im Bestand zirkuliert sein.

Exploring the Factor Structure of Financial Capacity in Cognitively Normal and Impaired Older Adults

OBJECTIVES

To investigate the factor structure of financial capacity using a direct-performance measure of financial skills (The Financial Capacity Instrument [FCI]) as a proxy for the financial capacity construct.

METHODS

The study sample was composed of 440 older adults who represented the cognitive spectrum from normal cognitive aging to mild cognitive impairment (MCI) to mild dementia: 179 healthy older adults, 149 participants with MCI, and 112 participants with mild Alzheimer's dementia (AD).

RESULTS

Both Velicer's Minimum Average Partial test and Horn's parallel analysis supported a four-factor solution which accounted for 46% of variance. The four extracted factors were interpreted as: (1) Basic Monetary Knowledge and Calculation Skills, (2) Financial Judgment, (3) Financial Conceptual Knowledge, and (4) Financial Procedural Knowledge.

CONCLUSIONS

The study findings represent an important first step in empirically articulating the financial capacity construct in aging. The four identified factors can guide both clinical practice and future instrument utilization and development.

CLINICAL IMPLICATIONS

Cognitively impaired older adults with MCI and mild AD dementia are likely to show financial changes in one or more of the four identified financial factors. Clinicians working with older adults should routinely examine for potential changes in these four areas of financial function.

Stereospecific Nickel-Catalyzed Borylation of Secondary Benzyl Pivalates

A stereoselective nickel-catalyzed direct borylation of enantioenriched secondary benzyl pivalates is described. This methodology is characterized by an intriguing cooperativity of simple nickel and copper salts to promote the targeted C–B bond formation under mild reaction conditions. Unlike classical SN2-type processes, this protocol occurs with a neat retention of configuration, resulting in synthetically versatile benzyl boronic esters with excellent stereochemical fidelity.

The Role of Cutaneous Microbiota Harmony in Maintaining a Functional Skin Barrier

Abstract Not Available

Microbiota, metabolome, and immune alterations in obese mice fed a high-fat diet containing type 2 resistant starch

SCOPE

We examined the intestinal and systemic responses to incorporating a type 2 resistant starch (RS) into a high fat diet fed to obese mice.

METHODS AND RESULTS

Diet-induced obese, C57BL/6J male mice were fed an HF diet without or with 20% (by weight) high-amylose maize resistant starch (HF-RS) for 6 weeks. Serum adiponectin levels were higher with RS consumption, but there were no differences in weight gain and adiposity. With HF-RS, the expression levels of ileal TLR2 and Reg3g and cecal occludin, TLR2, TLR4, NOD1 and NOD2 were induced; whereas colonic concentrations of the inflammatory cytokine IL-17A declined. The intestinal, serum, liver, and urinary metabolomes were also altered. HF-RS resulted in lower amino acid concentrations, including lower serum branched chain amino acids, and increased quantities of urinary di/trimethylamine, 3-indoxylsulfate, and phenylacetylglycine. Corresponding to these changes were enrichments in Bacteroidetes (S24-7 family) and certain Firmicutes taxa (Lactobacillales and Erysipelotrichaceae) with the HF-RS diet. Parabacteroides and S24-7 positively associated with cecal maltose concentrations. These taxa and Erysipelotrichaceae, Allobaculum, and Bifidobacterium were directly correlated with uremic metabolites.

CONCLUSION

Consumption of RS modified the intestinal microbiota, stimulated intestinal immunity and endocrine-responses, and modified systemic metabolomes in obese mice consuming an otherwise obesogenic diet.

Randomized phase II placebo-controlled study to evaluate the efficacy of topical pure emu oil for joint pain related to adjuvant aromatase inhibitor use in postmenopausal women with early breast cancer: JUST (Joints Under Study)

PURPOSE

Aromatase inhibitors are standard of care in women with hormone receptor-positive early breast cancer. Published evidence demonstrates that adverse effects may have an impact on drug compliance, with arthralgias being one of the most commonly reported adverse effects.

METHODS

Eligible patients were postmenopausal women who had experienced arthralgia following initiation of an aromatase inhibitor. Patients who experienced arthralgias following a minimum of a 3-month treatment on the aromatase inhibitor were randomized to emu oil or placebo oil. The primary endpoint was to assess for a reduction in pain as measured by a visual analogue score after 8 weeks of treatment.

RESULTS

Seventy-three patients comprised the intent-to-treat population, and there was no statistically significant benefit with use of EO. However, there was a statistically significant improvement in pain (visual analogue score was -1.28; p < 0.001) and Brief Pain Inventory severity score -0.88 (p < 0.001), as well as functional interference (Brief Pain Inventory interference -1.10 (p < 0.001) for the entire population following an 8-week administration of EO or placebo oil.

CONCLUSIONS

Arthralgias, as a result of aromatase inhibitor use, may be ameliorated by the use of topical oil massaged onto the joint. Further research into interventions for this common side effect is needed.

Secukinumab and Sustained Improvement in Signs and Symptoms of Patients With Active Ankylosing Spondylitis Through Two Years: Results From a Phase III Study

Objective

Secukinumab improved the signs and symptoms of ankylosing spondylitis (AS) over 52 weeks in the phase III MEASURE 2 study. Here, we report longer‐term (104 weeks) efficacy and safety results.

Methods

Patients with active AS were randomized to subcutaneous secukinumab 150 mg, 75 mg, or placebo at baseline; weeks 1, 2, and 3; and every 4 weeks from week 4. The primary end point was the Assessment of SpondyloArthritis international Society criteria for 20% improvement (ASAS20) response rate at week 16. Other end points included ASAS40, high‐sensitivity C‐reactive protein, ASAS5/6, Bath Ankylosing Spondylitis Disease Activity Index, Short Form 36 health survey physical component summary, ASAS partial remission, EuroQol 5‐domain measure, and Functional Assessment of Chronic Illness Therapy fatigue subscale. End points were assessed through week 104, with multiple imputation for binary variables and a mixed‐effects model repeated measures for continuous variables.

Results

Of 219 randomized patients, 60 of 72 (83.3%) and 57 of 73 (78.1%) patients completed 104 weeks of treatment with secukinumab 150 mg and 75 mg, respectively; ASAS20/ASAS40 response rates at week 104 were 71.5% and 47.5% with both secukinumab doses, respectively. Clinical improvements with secukinumab were sustained through week 104 across all secondary end points. Across the entire treatment period (mean secukinumab exposure 735.6 days), exposure‐adjusted incidence rates for serious infections and infestations, Crohn's disease, malignant or unspecified tumors, and major adverse cardiac events with secukinumab were 1.2, 0.7, 0.5, and 0.7 per 100 patient‐years, respectively. No cases of tuberculosis reactivation, opportunistic infections, or suicidal ideation were reported.

Conclusion

Secukinumab provided sustained improvement through 2 years in the signs and symptoms of AS, with a safety profile consistent with previous reports.