Tropomyosin receptor kinase inhibitors: an updated patent review for 2016-2019

Introduction: Tropomyosin receptor kinases (Trks) control processes in the fields of growth, survival, and differentiation of neuronal processes. They also play a crucial role in neurodegenerative diseases as well as different types of cancer. Interest in developing Trk inhibitors to target NTRK fusion-driven cancers has escalated in the last decade, leading to the FDA approval of the pan-Trk inhibitors entrectinib and larotrectinib. The development of next-generation inhibitors that overcome resistance mutations arising from treatment with these first generation inhibitors has been the focus in recent years.Area covered: In this updated patent review for 2016-2019, patents covering inhibitors targeting the Trk family are discussed as a continuation of the previous reviews, Tropomyosin receptor kinase inhibitors: an updated patent review for 2010-2016 - Parts 1 & 2. The status of Trk inhibitors in clinical trials is also evaluated. For the identification of relevant patents and clinical trials, Web of Science, Google, Google Patents, and patent referencing were used.Expert opinion: The FDA approval of larotrectinib and entrectinib is a prime example of how basket clinical trial design targeting oncogenic drivers, regardless of tumor histology, is a viable approach to drug discovery and embodies the shift toward personalized medicine.

Rationale for using insensitive quality control rules for today's hematology analyzers

Diverse approaches have been used to assure the analytical quality of automated hematology; as such, there is great variation in their error detection capabilities. We summarize the intralaboratory performance of a cohort of Sysmex XE-2100's running e-Check hematology quality control (QC). The imprecisions of a median performing (50th percentile imprecision) and more imprecise [15th percentile (15P) imprecision] Sysmex XE-2100 are compared with measures of total allowable error (regulatory and physiologically based) to obtain multiples of the usual imprecision that must be detected to prevent the hematology analyzer from producing medically unacceptable results. The resultant large multiples of the usual imprecision (s) demonstrate the need for insensitive QC rules employing very broad control ranges, control rules that have been implicitly supported by hematology analyzer manufacturers for the last several decades. For today's highly precise hematology analyzers, the following control rules are strongly advised: 1(3.5s) , 1(4s) and 1(4.5s) rules (violated if a single control observation exceeds either its ±3.5, ±4.0 and ±4.5s limits, respectively). In order for the hematology laboratory to totally embrace expanded QC limits, manufacturers must make available their instruments' usual and poorer (e.g. the 15P performance) imprecision's. Users of hematology analyzers that require more sensitive but less specific rules to prevent the reporting of clinically erroneous data are advised to acquire more precise (and thus more dependable) instrumentation.

Streptococcal cell wall-induced arthritis: requirements for IL-4, IL-10, IFN-gamma, and monocyte chemoattractant protein-1

Intra-articular injection of streptococcal cell wall Ag followed by i.v. challenge ("reactivation") results in a destructive lymphocyte-dependent monoarticular arthritis. To further define the role of immune mechanisms in the model, Abs to Th1 and Th2-related cytokines were evaluated. Treatment of rats with antibodies to IL-4 reduced swelling, while treatment with anti-IL-10 or anti-IFN-gamma either had no effect or slightly enhanced the inflammatory response. These results suggest that Th-2 immune mechanisms may be, at least in part, operative in the model. To more precisely define the role of IL-4, the effects of anti-IL-4 on monocyte chemoattractant protein-1 (MCP-1) expression were evaluated. Initial studies demonstrated that mRNA (as determined by in situ hybridization) and protein (as determined by immunofluorescence) for MCP-1 were detectable in inflamed synovial tissue in a time-dependent manner. Anti-IL-4 treatment significantly reduced the expression of mRNA for MCP-1 24 and 72 h after reactivation. In addition, anti-MCP-1 inhibited swelling and reduced influx of (111)In-labeled T cells. These data suggest that the reactivation model of streptococcal cell wall Ag-induced arthritis is Th-2 dependent, and that an inter-relationship exists between IL-4 and the expression of MCP-1.