P(III) vs P(V): A P(V) Reagent for Thiophosphoramidate Linkages and Application to an Asymmetric Synthesis of a Cyclic Dinucleotide STING Agonist

A highly stereoselective synthesis of a cyclic dinucleotide (CDN) STING agonist containing two chiral thiophosphoramidate linkages is described. These rare yet key functional groups were, for the first time, installed efficiently and with high diastereoselectivity using a specially designed P(V) reagent. By utilizing this strategy, the CDN was prepared in greater than 16-fold higher yield than the prior P(III) approach, with fewer hazardous reagents and chromatographic purifications.

P(III) vs P(V): A P(V) Reagent for Thiophosphoramidate Linkages and Application to an Asymmetric Synthesis of a Cyclic Dinucleotide STING Agonist

A highly stereoselective synthesis of a cyclic dinucleotide (CDN) STING agonist containing two chiral thiophosphoramidate linkages is described. These rare yet key functional groups were, for the first time, installed efficiently and with high diastereoselectivity using a specially designed P(V) reagent. By utilizing this strategy, the CDN was prepared in greater than 16-fold higher yield than the prior P(III) approach, with fewer hazardous reagents and chromatographic purifications.

Phase II trial of ipilimumab in melanoma patients with preexisting humoural immune response to NY-ESO-1

BACKGROUND

Immune checkpoint therapy has dramatically changed treatment options in patients with metastatic melanoma. However, a relevant part of patients still does not respond to treatment. Data regarding the prognostic or predictive significance of preexisting immune responses against tumour antigens are conflicting. Retrospective data suggested a higher clinical benefit of ipilimumab in melanoma patients with preexisting NY-ESO-1-specific immunity.

PATIENTS AND METHODS

Twenty-five patients with previously untreated or treated metastatic melanoma and preexisting humoural immune response against NY-ESO-1 received ipilimumab at a dose of 10 mg/kg in week 1, 4, 7, 10 followed by 3-month maintenance treatment for a maximum of 48 weeks. Primary endpoint was the disease control rate (irCR, irPR or irSD) according to immune-related response criteria (irRC). Secondary endpoints included the disease control rate according to RECIST criteria, progression-free survival and overall survival (OS). Humoural and cellular immune responses against NY-ESO-1 were analysed from blood samples.

RESULTS

Disease control rate according to irRC was 52%, irPR was observed in 36% of patients. Progression-free survival according to irRC was 7.8 months, according to RECIST criteria it was 2.9 months. Median OS was 22.7 months; the corresponding 1-year survival rate was 66.8%. Treatment-related grade 3 AEs occurred in 36% with no grade 4-5 AEs. No clear association was found between the presence of NY-ESO-1-specific cellular or humoural immune responses and clinical activity.

CONCLUSION

Ipilimumab demonstrated clinically relevant activity within this biomarker-defined population. NY-ESO-1 positivity, as a surrogate for a preexisting immune response against tumour antigens, might help identifying patients with a superior outcome from immune checkpoint blockade.

CLINICAL TRIAL INFORMATION

NCT01216696.

Microfluidic Devices Made of Glass

Mikroglas is a young, innovative and highly-specialized enterprise, which has special know-how in the development of microstructured glass components. Due to its unique properties, glass plays an important role in the field of microtechnology. Most important for many of these new applications are:

• its optical transparency and good fluorescence properties, allowing the user to carry out in-situ-measurements, e.g., to detect products after a chemical reaction directly in the device • its stability at high temperatures so that reactions can be influenced by heating different zones of the device • its chemical resistivity, e.g., to handle aggressive substances • its high electrical resistivity, e.g., to transport liquids by electrophoresis or to carry out electrical measurements • its good biological compatibility which is necessary for medical and biological applications

The process of structuring FOTURAN will be described. With this technology different microfluidic devices have been manufactured. The channels have a width and depth of 50 μm up to 1 mm and a length of 20 mm up to 280 mm. Various parameters have been measured, e. g., the heat exchange and transfer coefficient for pure water as a function of the temperature. Also optical and thermal analysis techniques have been used to characterize the fluidic components. The results combined with advanced computational fluidic simulations lead to new solutions for different tasks.

Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi-resistant bacteria

BACKGROUND

This study examined characteristics of adult and adolescent patients with cystic fibrosis (CF) to determine factors associated with an increased risk of pulmonary exacerbations.

METHODS

249 patients with CF infected with multidrug resistant bacteria were recruited and prospectively followed for up to 4.5 years until they experienced a pulmonary exacerbation severe enough to require intravenous antibiotics. Multivariable regression analyses were used to compare the characteristics of patients who experienced an exacerbation with those who did not.

RESULTS

124 of the 249 patients (50%) developed a pulmonary exacerbation during the first year and 154 (62%) experienced an exacerbation during the 4.5 year study period. Factors predictive of exacerbations in a multivariable survival model were younger age (OR 0.98, 95% CI 0.96 to 0.99), female sex (OR 1.45, 95% CI 1.07 to 1.95), lower forced expiratory volume in 1 second (FEV(1)) (OR 0.98, 95% CI 0.97 to 0.99), and a previous history of multiple pulmonary exacerbations (OR 3.16, 95% CI 1.93 to 5.17). Chronic use of inhaled corticosteroids was associated with an increased risk of exacerbation (OR 1.92, 95% CI 1.00 to 3.71) during the first study year.

CONCLUSIONS

Patients who experience pulmonary exacerbations are more likely to be younger, female, using inhaled steroids, have a lower FEV(1), and a history of multiple previous exacerbations. It is hoped that knowledge of these risk factors will allow better identification and closer monitoring of patients who are at high risk of exacerbations.

Adjudicating ventilator-associated pneumonia in a randomized trial of critically ill patients

PURPOSE

The purpose of this study was to evaluate an adjudication strategy for diagnosing ventilator-associated pneumonia (VAP) in a randomized trial.

MATERIALS AND METHODS

In a double-blind trial of sucralfate versus ranitidine, one of four pairs of adjudicators examined each case of clinically suspected VAP. Nurse and physician notes and all relevant laboratory data were allocated to each adjudication pair in groups of five patients. Each reader in the pair decided whether the patient had VAP; differences were resolved by consensus discussion.

RESULTS

The overall unadjusted study odds ratio for VAP was 0.82 (P = .21) representing a trend toward less pneumonia with sucralfate compared with ranitidine. The odds ratio adjusted for adjudication pair was 0.85 (P = .27). The proportion of charts adjudicated as VAP positive among pairs ranged from 50% to 92%; crude agreement between readers in each pair varied from 50% to 82%. When adjudicators disagreed, the final consensus was split evenly between the two adjudicators' initial opinions in two pairs; in the other two pairs, the final decision reflected one dominant initial opinion. Personnel time to adjudicate all patients with a suspicion of VAP was 74 days.

CONCLUSIONS

Though adjudication of outcomes such as VAP is time-consuming, consistent decision-making requires strict criteria, training, and calibration. Patients should be assigned to adjudication teams through random allocation.

Phosphodiesterase inhibitors suppress alpha2-adrenoceptor-mediated 5-hydroxytryptamine release from tracheae of newborn rabbits

The outflow of 5-hydroxytryptamine (5-HT) from isolated tracheae of newborn rabbits was determined by high pressure liquid chromatography with electrochemical detection. This 5-HT outflow reflects release from neuroendocrine epithelial cells of the airway mucosa, as previously shown. Phenylephrine, via alpha2B-adrenoceptors, caused a transient increase in 5-HT outflow, maximally by about 250%, an effect mediated by liberation of intracellular Ca2+, as previously shown. The non-selective phosphodiesterase inhibitor 2-isobutyl-1-methylxanthine (IBMX) concentration-dependently inhibited phenylephrine-induced 5-HT release (completely at 100 microM, IC50: 1.3 microM). Likewise, benzafentrine (inhibitor of phosphodiesterase 3 and 4) and siguazodan (inhibitor of phosphodiesterase 3) also almost completely inhibited phenylephrine-induced 5-HT release with IC50 values of 1.7 and 4.2 microM, respectively. Rolipram (inhibitor of phosphodiesterase 4), in a concentration of 10 microM, which exceeds more than 10-fold the reported IC50 for phosphodiesterase 4, did not significantly affect phenylephrine-induced 5-HT release. 5-HT release induced by depolarizing concentrations of K+ (45 mM), which largely depends on extracellular Ca2+, was not affected by IBMX. In conclusion, phosphodiesterases, with characteristics of phosphodiesterase 3, appear to play an important role in the control of cyclic nucleotide mediated inhibition of 5-HT release from neuroendocrine epithelial cells.

Nitric oxide, via activation of guanylyl cyclase, suppresses alpha2-adrenoceptor-mediated 5-hydroxytryptamine release from neuroendocrine epithelial cells of rabbit tracheae

Isolated tracheae of newborn rabbits were incubated in vitro and the outflow of 5-hydroxytryptamine (5-HT) was determined by HPLC with electrochemical detection. Evidence has previously been provided that this 5-HT outflow derives from neuroendocrine epithelial (NEE) cells of the airway mucosa. Phenylephrine, at a maximally effective concentration of 10 microM, caused a transient increase in 5-HT outflow by about 250%, an effect mediated by alpha2B-adrenoceptors, as previously shown. The phenylephrine-induced 5-HT release remained unchanged in calcium-free medium, but was reduced by 75% when the tracheae were incubated in calcium-free medium which contained 0.5 mM EDTA, a treatment known to lower also intracellular calcium. The NO donor SNAP (S-nitroso-N-acetyl-penicillinamine, 10 microM) almost completely inhibited phenylephrine-induced 5-HT release. The inhibitory effect of SNAP was prevented by ODQ, (1H-[1, 2, 4]oxadiazolo[4, 3-a]quinoxalin-1-one), an inhibitor of soluble guanylyl cyclase. In contrast, 5-HT release induced by depolarizing concentrations of potassium (45 mM), which was reduced by 96% in calcium-free medium, was not affected by SNAP. In conclusion, NO, via activation of soluble guanylyl cyclase, inhibits 5-HT release from NEE cells in a stimulus-dependent manner. Alpha2-adrenoceptor-mediated 5-HT release, which appears to be triggered by liberation of calcium from intracellular stores, is suppressed by NO, whereas high potassium-evoked 5-HT release which is triggered by calcium influx through voltage regulated channels, is not affected.

The immune response in halo nevi

The mechanism(s) responsible for halo nevus presents a provocative link with the immune response to melanoma. Although no direct demonstration of melanocyte killing has been observed by the immune effector cells found within the halo, the abundance of antigen-presenting cells in the regressing nevus and the presence of T lymphocytes at the site of depigmentation suggest that these cells participate in the halo phenomenon. Within the latter population of cells, evidence points to the involvement of CD8+ T cells as potential effectors in the destruction of nevomelanocytes. The break in tolerance that triggers migration and the presumed activation of these and other lymphocytes in the nevus in the apparent absence of disease remains unexplained. This brief overview reviews the evidence for the participation of the immune response in the genesis of the halo nevus.

Adrenoceptor- and cholinoceptor-mediated mechanisms in the regulation of 5-hydroxytryptamine release from isolated tracheae of newborn rabbits

1. Isolated tracheae of newborn rabbits were incubated in vitro and the outflow of 5-hydroxytryptamine (5-HT) was determined by h.p.l.c. with electrochemical detection. Evidence has previously been provided that this 5-HT outflow derives from neuroendocrine epithelial (NEE) cells of the airway mucosa. 2. Phenylephrine (1, 10 and 30 microM) enhanced the outflow of 5-HT by 80, 290 and 205%, respectively. 5-HT outflow evoked by 10 microM phenylephrine was not affected by the presence of the neurotoxin tetrodotoxin (1 microM). 3. Rauwolscine, ARC 239 (an alpha(2B)-adrenoceptor preferring antagonist), yohimbine and prazosin antagonized the effect of 10 microM phenylephrine in a concentration-dependent manner with IC50 values of 150, 295, 300 and 1,700 nM, respectively. Comparison of the ratios (between all antagonists) of the present IC50 values with the corresponding ratios of Ki values obtained in binding studies for the alpha(2A)-, alpha(2B)-, alpha(2C)- and alpha(2D)-adrenoceptor subtypes strongly suggests the involvement of an alpha(2B)-receptor. 4. 5-HT outflow evoked by 10 microM phenylephrine was inhibited by 65% in the presence of 1 microM forskolin and abolished in the presence of 10 microM forskolin. 5. 5-HT outflow evoked by 10 microM phenylephrine was inhibited by about 45 and 70% in the presence of 0.1 and 1 microM isoprenaline, respectively. The inhibitory effect of 1 microM isoprenaline was only marginally antagonized by 1 microM, but blocked by 10 microM propranolol. 6. 5-HT outflow was not affected by the muscarine receptor agonist oxotremorine (10 microM), but was enhanced by 175% by 100 microM nicotine. The effect of nicotine was blocked by 100 microM hexamethonium and prevented by 1 microM tetrodotoxin or 1 microM yohimbine. 7. In conclusion, 5-HT release from NEE cells of the rabbit trachea is stimulated via alpha-adrenoceptors most likely of the alpha(2B)-subtype localized directly at the NEE cells. Activation of beta-adrenoceptors as well as direct activation of adenylyl cyclase by forskolin exert inhibitory effects on 5-HT release. Activation of nicotinic, but not of muscarinic receptors, also evokes the release of 5-HT. However, the effect of nicotine appears to be mediated indirectly via the release of noradrenaline.

[ARDS caused by military zinc fumes exposure]

A previously healthy 19-year-old male was exposed to concentrated hexite smoke (ZnCl2) for several minutes during military training. The initial symptoms (vomiting, cough, dyspnea) disappeared after a few hours. After 48 hours the patient developed acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation for 8 days. He left hospital 10 days after extubation. Spirometry at this time revealed a restrictive defect (vital capacity 50% predicted). Four months after the accident the patient had returned to work without symptoms of respiratory insufficiency. Lung function tests had normalized with the exception of a slight reduction in carbon monoxide diffusion. This case illustrates the typical course of inhalative intoxication with hexite. It underlines the importance of prolonged clinical surveillance in view of the latency between the initial symptoms of hexite intoxication and possible later development of ARDS.

Effects of bacterial lipopolysaccharides (LPS) and tumour necrosis factor-alpha (TNF alpha) on rat tracheal epithelial cells in culture: morphology, proliferation and induction of nitric oxide (NO) synthase

Rat tracheal epithelial cells were cultured and the effects of LPS and TNF alpha on cell morphology, rate of proliferation and NO synthase activity were studied. NO synthase activity was determined by measuring the accumulation of 3H-L-citrulline during incubation of confluent monolayer with 3H-L-arginine. In untreated cells no significant 3H-L-citrulline formation was detected, and bradykinin and the calcium ionophore A 23187 failed to stimulate 3H-L-citrulline formation excluding a constitutively expressed, calcium-dependent NO synthase activity. After culturing the cells for 18 h in the presence of LPS (10 micrograms/ml) and TNF alpha (500 U/ml) a marked formation of 3H-L-citrulline could be detected, which was largely inhibited by N(G)-monomethyl-L-arginine (L-NMMA) indicating the induction of NO synthase activity which could be prevented by dexamethasone. Exposure of confluent monolayer to LPS and TNF alpha for up to 4 days resulted in a reduction in cell density by 20% within 1 to 2 days and in additional marked changes in cell morphology. The normal honeycomb-like structure of the culture was lost and a considerable number of cells developed "dendritic' outgrowths. These morphological changes as well as the reduction in cell density was attenuated by dexamethasone, but not by the NO synthase inhibitor L-NMMA. The rate of cell proliferation was determined in non-confluent cultures 24 h after passage by determination of the incorporation of tritium into DNA during 24 h of incubation with 3H-thymidine. 3H-thymidine incorporation was reduced by about 40-45% when LPS or TNF alpha was present during exposure to 3H-thymidine, and by about 65%, when LPS and TNF alpha were present in combination. Neither L-NMMA nor dexamethasone significantly affected the 3H-thymidine incorporation nor the inhibitory effects of LPS and TNF alpha. In conclusion, airway epithelial cells are markedly affected by LPS and TNF alpha and the various responses (changes in the cell morphology, inhibition of cell proliferation and induction of NO synthase activity) appear to be caused by different (dexamethasone-sensitive and -insensitive), cellular mechanisms. An enhanced formation of endogenous NO may not be responsible for the observed morphological changes or the inhibition of cell proliferation.

Characterization of 5-hydroxytryptamine release from isolated rabbit and rat trachea: the role of neuroendocrine epithelia cells and mast cells

Rabbit or rat isolated tracheae were incubated in vitro, and the release of 5-hydroxytryptamine (5-HT) and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) was determined by HPLC with electrochemical detection. Release of 5-HT from rabbit tracheae could be evoked by the calcium ionophore A 23187 and, in a calcium-dependent manner, by depolarizing concentrations of potassium (45 mmol/l), but not by the mast cell degranulating drug compound 48/80. High potassium- and A 23187-evoked release of 5-HT was markedly higher from tracheae of newborn compared to adult rabbits. In rabbit tracheae, mechanical removal of the mucosa resulted in 80-90% reduction in tissue 5-HT and in a similar reduction in high potassium-evoked 5-HT release. 5-Hydroxytryptophan, but not tryptophan, caused a marked increase in the spontaneous outflow of 5-HT and 5-HIAA from tracheae of newborn rabbits, and the effect on 5-HT, but not that on 5-HIAA, required an intact mucosa. Furthermore, treatment with 5-hydroxytryptophan caused an increase in tissue 5-HT and 5-HIAA, and these effects required an intact mucosa. In tracheae of adult rabbits 5-hydroxytryptophan caused similar, although less profound, effects. Adrenaline (1 micromol/1) enhanced the release of 5-HT from newborn rabbit tracheae, and this effect was inhibited by 1 micro mol/l phentolamine or 1 micromol/1 prazosin, but not affected by 100 nmol/1 propranolol. In rat tracheae, compound 48/80 evoked a large release of 5-HT, whereas depolarizing concentrations of potassium (45 mmol/1) had only a very minor effect. In rat tracheae, 5-hydroxytryptophan had small effects on the outflow and tissue contents of 5-HT and 5-HIAA in comparison to the effects on rabbit tracheae; and removal of the mucosa resulted in only a minor reduction in tissue 5-HT. In conclusion, neuroendocrine epithelial (NEE) cells and mast cells are the major source of 5-HT in tracheae of the rabbit and rat, respectively. Isolated tracheae of newborn rabbits appear to be a useful model to study 5-HT secretion from NEE cells. 5-HT secretion from NEE cells is activated by a rise in intracellular calcium, and calcium influx through voltage-regulated channels appears to be one activating pathway. 5-HT secretion from NEE cells can be stimulated via alpha-adrenoceptors.

Effect of a platelet activating factor antagonist, WEB 2086, on allergen induced asthmatic responses

BACKGROUND

Platelet activating factor (PAF) has been implicated in the pathogenesis of airway hyperresponsiveness in asthma. The purpose of this study was to evaluate the effects of a selective PAF antagonist (WEB 2086), given in doses known to antagonise the effects of inhaled PAF in human subjects, on allergen induced early and late asthmatic responses and on airway hyperresponsiveness.

METHODS

Eight atopic, mildly asthmatic subjects were studied during a screening period and two treatment periods. During the screening period subjects inhaled an allergen to which they were known to be sensitised and the response was measured as the fall in the forced expired volume in one second (FEV1) to show the presence of early (0-1 h) and late (3-7 h) asthmatic responses. On another day the subjects inhaled allergen diluent. During the treatment periods subjects inhaled allergen after one week's pretreatment with WEB 2086 (100 mg three times a day) or placebo administered in a randomised, double blind, crossover fashion. Histamine airway responsiveness was measured 24 hours before and 24 hours after allergen and the results were expressed as the provocative concentration causing a 20% fall in FEV1 (PC20).

RESULTS

The maximal early asthmatic response after allergen with placebo treatment was 18.4% (SE 4.4%) and with WEB 2086 18.9% (4.4%). The maximal late response with placebo treatment was 21.7% (5.3%) and with WEB 2086 21.2% (3.0%). The log difference (before and after allergen) in histamine PC20 was 0.35 (0.06) after placebo treatment and 0.30 (0.1) after WEB 2086.

CONCLUSIONS

These results indicate that one week of treatment with an orally administered PAF antagonist (WEB 2086) does not attenuate allergen induced early or late responses or airway hyperresponsiveness.

Automated histometry in fibrocystic breast disease

Ductal epithelial proliferations of the mammary gland in biopsy material from 101 patients, including 52 with proliferative fibrocystic disease (mastopathy), were quantitatively analyzed by means of the Robotron A 6471 system together with AMBA/R software. Based on reproducible data obtained for distinct karyometric and histometric features, significant differences were found to exist between epithelial proliferations without atypical hyperplasia (mastopathy II) and those with atypia (mastopathy III). The multiparameter analysis also produced some hints that cases of proliferative mastopathy III can be divided into two groups having different risks of developing carcinoma.

Unresponsiveness to experimental allergic encephalomyelitis in Lewis rats pretreated with complete Freund's adjuvant

A single injection of complete Freund's adjuvant blended with aluminum hydroxide gel (ALU-CFA) was successfully used to prevent clinical as well as histologic experimental allergic encephalomyelitis (EAE) in Lewis rats for more than 330 days. Adjuvant preparations with Mycobacterium tuberculosis were more potent than those with Mycobacterium butyricum. Neither the removal of the ALU-CFA inoculum nor a splenectomy 1 month after immunization arrested the adjuvant induced unresponsiveness. However cyclophosphamide restored responsiveness in more than half of the treated animals when applied 2 days before the encephalitogenic challenge at a dose of 20 mg/kg. Passive EAE was not prevented by the ALU-CFA pretreatment. The disease was induced by the transfer of 4 X 10(6) T lymphocytes of a cell line reactive against myelin basic protein. This indicates that the adjuvant prevents EAE at the inductive rather than at the effector phase of the autoimmune response.

[Effect of a fixed betablocker diuretic combination in hypertension compared with the effect of the single components (author's transl)]

In a double blind designed treatment trial with three randomized groups of patients the effect of a fixed betablocker diuretic combination (Torrat, Boehringer Mannheim GmbH) was compared with the effect of the single components. 66 patients with essential and renal hypertension stage I and II according to the WHO definition were evaluated. 27 patients were treated with 1 tablet, 32 with 2 X 1 tablet, and 7 patients with 3 X 1 tablet daily. Besides of the blood pressure lowering effect over an observation period of 10 weeks the influence on pulse rate, potassium, blood sugar and uric acid were investigated. It could be shown that the blood pressure lowering effect was highest under the combination-drug. The treatment with the single components showed a less pronounced influence on the blood pressure, thus hinting at an additive effect of the 2 components metipranolol and butizide when given together. The combination exerts few side effects and does not influence the investigated parameters of metabolism over a longer period of time.

Aminophylline injection and theophylline tablets: Acute response in partially reversible chronic airway obstruction

Intravenous injections of aminophylline (250 mg) and tablets of theophylline (Neulin) (400 mg) were given, on separate occasions, to 10 patients with partially reversible severe airway obstruction. The dose of aminophylline was shown to be inadequate on the basis of the unsatisfactory plasma theophylline levels and a poor ventilatory response. Two hours after oral administration of theophylline, a mean plasma theophylline concentration in the optimal range (10 to 20 mug/ml) was reached, and a consistent improvement in the mean forced expiratory volume in one second (FEV1) occurred. A further large improvement in FEV1 after inhalation of salbutamol showed that the improvement in ventilation with the theophylline tablets, although consistent, was less than maximal.