Anti-CD154 (CD40L) prevents recurrence of diabetes in islet isografts in the DR-BB rat

Islet transplantation for the treatment of autoimmune diabetes is more difficult because of the additional barrier presented by the autoimmunity. We tested the ability of hamster anti-rat CD154 to prevent recurrence of diabetes in renal subcapsular islet isografts in DR-BB (RT1uu) rats with established autoimmune diabetes. Experimental animals with established diabetes received intravenous injections of 15 mg/kg anti-CD154 on a specified schedule starting 2 days before renal subcapsular transplantation of an islet isograft. Control animals received either saline or hamster IgG. Plasma glucose levels >250 mg/dl over 3 days were used to indicate the recurrence of diabetes. Rats that received saline (n = 5) or control antibody (n = 3) had a recurrence of diabetes 6-11 days after transplantation. Histological examination of islet isografts from these rats showed complete destruction of the insulin-producing portion of the isograft with residual cells positive for glucagon. Recipient rats that received anti-CD154 at the 15-mg/kg dosage (n = 6) did not have a recurrence of diabetes for 308-461 days after transplantation. Islet isografts removed from the rats showed low levels of insulin immunoreactivity, high levels of insulin mRNA, and focal infiltration with lymphocytes but no evidence of islet destruction. Mean peak antibody concentration was 266 microg/ml and returned to undetectable levels by 67-88 days after transplantation. Rats that received anti-CD154 starting at 4-7 days after transplantation had a recurrence of diabetes within 11 days of the isotransplantation. Therefore, anti-CD154 as the sole immunomodulator prevented the recurrence of diabetes in islet isografts in rats with established autoimmune diabetes. This suggests that CD40/CD154 blockade is effective in preventing the insulitis or the effector phase of autoimmune diabetes.

Compassionate use of continuous prostacyclin in the management of secondary pulmonary hypertension: a case series

BACKGROUND

Treatment of patients with secondary pulmonary hypertension has been unsatisfactory.

OBJECTIVE

To describe exercise capacity, functional class, and hemodynamic variables after long-term intravenous infusion of prostacyclin in patients with secondary pulmonary hypertension.

DESIGN

Case series.

SETTING

Academic referral center.

PATIENTS

33 patients with secondary, precapillary pulmonary hypertension (New York Heart Association class III or IV).

INTERVENTION

Continuous intravenous prostacyclin administered by portable infusion pump on a compassionate-use basis.

MEASUREMENTS

Functional class, treadmill time, and hemodynamic variables.

RESULTS

Patients were followed for an average of 12.7 +/- 5.6 months. Exercise tolerance and New York Heart Association class improved in each patient. The duration of treadmill exercise increased from 186 seconds to 491 seconds, an increase of 305 seconds (95% CI, 194 to 417 seconds; P < 0.001). Mean pulmonary artery pressure decreased from 60 mm Hg to 46 mm Hg, a decrease of 14 mm Hg (CI, 9 to 19 mm Hg; P < 0.001). Cardiac output increased from 3.90 L/min to 6.30 L/min, an increase of 2.40 L/min (CI, 1.56 to 3.25 L/min; P < 0.001). The pulmonary vascular resistance decreased from 1143 dynes x s/cm5 to 575 dynes x s/cm5, a decrease of 567 dynes x s/cm5 (CI, 407 to 727 dynes x s/cm5; P < 0.001). Patients with collagen vascular disease, congenital heart disease, and portopulmonary hypertension were analyzed with other patients and separately. All groups had a statistically significant reduction in mean pulmonary artery pressure and a statistically significant increase in cardiac output.

CONCLUSION

Intravenous prostacyclin may be effective in the treatment of patients with certain types of secondary pulmonary hypertension.

Pharmacokinetics/dynamics of 5c8, a monoclonal antibody to CD154 (CD40 ligand) suppression of an immune response in monkeys

The pharmacokinetics and pharmacodynamics (PK/PD) of chimeric (Ch5c8) and humanized (Hu5c8) 5c8, a monoclonal antibody that binds CD154 (CD40 ligand), thus blocking the interaction between CD40 and CD154, were investigated in cynomolgus monkeys. Single-dose groups (n = 3 animals per dose) received saline, 0.2, 1, 5 or 20 mg/kg i.v. doses of Hu5c8. The repeat-dose groups (n = 4 animals) received 0 or 5 mg/kg i.v. doses of Ch5c8 or Hu5c8 on days 1, 2, 3, 5, 7 and 9. The single-dose PK parameters showed dose proportionality, with a terminal half-life of 300 h, a volume of distribution at steady state of 73 ml/kg and clearance of 0.2 ml.h-1.kg-1. The repeat-dose regimen produced a longer terminal half-life (500 h) and lower clearance (0.13 ml.h-1.kg-1) than in the single-dose groups. The antibody titer to tetanus toxoid (ATT) challenge served as the immunodynamic marker. The primary ATT response consisted of a latent phase of approximately 10 days, during which the immune system was processing antigen but not yet producing antibody, a rise to an antibody maximum titer at approximately 18 days and a decline toward baseline by approximately 40 days in controls. The 5c8 produced a log(dose)-proportional reduction in the area under the curve of ATT. An indirect PK/PD model based on the kinetics of tetanus toxoid exposure and inhibition of ATT production in relation to 5c8 concentrations was developed. A median inhibitory concentration of 0.84 microg/ml and a efficacy of 0.84 reflected marked inhibition of ATT response by 5c8. The model provides quantitation of reduced ATT responses after 5c8 and was applicable to primary and secondary immune responses and to both single-dose and multiple-dose treatments. The monoclonal antibody 5c8 blocks the CD40 and CD154 interaction, producing consistent and substantive reduction in antibody formation after administration of tetanus toxoid, which can be characterized with PK/PD modeling. It is anticipated that 5c8 may have utility in the treatment of antibody-mediated autoimmune disease.

Glass-ceramic-mediated, magnetic-field-induced localized hyperthermia: response of a murine mammary carcinoma

Hyperthermia has been found to be a useful modality for cancer therapy. In this report, a biocompatible, ferrimagnetic glass-ceramic capable of inducing localized hyperthermia by hysteresis heating upon exposure to an alternating magnetic field is presented. When the glass-ceramic was placed in the region of a subcutaneously transplanted, weakly antigenic breast carcinoma and subjected to the magnetic field, sufficient temperature rise was obtained to cause significant (approximately 50%) tumor regrowth delay and a 12% permanent control. The data demonstrate that glass-ceramic-mediated hysteresis heating may be a useful therapeutic approach in the treatment of cancer which offers the advantage of producing a highly localized and predictable tumor volume hyperthermia.

Separation of bovine spermatozoa by density on water insoluble Newtonian gels and their use for insemination

Bovine spermatozoa were separated into different density subpopulations utilizing water insoluble hydrocarbon and silicone gels of defined specific gravity. Sperm density profiles were generated for 13 bulls. The separations were found to be repeatable and characteristic of the bull examined. Considerable density variation among animals was demonstrated. Analysis of the separated spermatozoa, before and after freezing, demonstrated that good motility and acrosomal integrity of spermatozoa were maintained. When the least dense fraction of spermatozoa was used for insemination, conception rates were similar to those obtained routinely by artificial insemination with unfractionated spermatozoa. Therefore, this system may be useful in separating spermatozoa of various densities and for removing extraneous matter from semen. However, the sex ratio, among 51 60-day-old fetuses recovered from heifers inseminated with the lowest density fraction of spermatozoa, was 26 males:25 females.