Characterization of the in vitro and in vivo properties of CFZ533, a blocking and non-depleting anti-CD40 monoclonal antibody

The CD40-CD154 costimulatory pathway is essential for T cell-dependent immune responses, development of humoral memory, and antigen presenting cell function. These immune functions have been implicated in the pathology of multiple autoimmune diseases as well as allograft rejection. We have generated CFZ533, a fully human, pathway blocking anti-CD40 monoclonal antibody that has been modified with a N297A mutation to render it unable to mediate Fcγ-dependent effector functions. CFZ533 inhibited CD154-induced activation of human leukocytes in vitro, but failed to induce human leukocyte activation. Additionally, CFZ533 was unable to mediate depletion of human CD40 expressing B cells. In vivo, CFZ533 blocked primary and recall T cell-dependent antibody responses in nonhuman primates and abrogated germinal formation without depleting peripheral blood B cells. We also established a relationship between plasma concentrations of CFZ533 and CD40 pathway-relevant pharmacodynamic effects in tissue. Collectively these data support the scientific rationale and posology for clinical utility of this antibody in select autoimmune diseases and solid organ transplantation.

Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: long-term results

OBJECTIVE

To evaluate the long-term outcomes of bariatric surgery with respect to respiratory disturbance index (RDI) in sleep apnea syndrome (SAS).

DESIGN

Case series with long-term follow-up (1 to 12 years).

SETTING

Private clinic in an academic tertiary referral center.

PATIENTS

Fifteen morbidly obese patients (10 men, 5 women) who were referred for the treatment of severe SAS.

INTERVENTION

For all 15 patients who presented with severe SAS, nasal positive airway pressure breathing was either not available or was not tolerated by the patient; therefore, bariatric surgery was performed as a means of treatment for SAS.

MAIN OUTCOME MEASURES

RDIs and minimum oxygen saturation were measured both preoperatively and postoperatively (1 to 12 years after surgery).

RESULTS

Weight loss ranged from 60 to 220 pounds (27 to 100 kg). RDI decreased by at least 55% in each patient, and all patients with tracheostomies (8 of 15) had their tracheostomy tubes removed. Average RDI preoperatively was 96.9 and average RDI postoperatively was 11.3. Results were similar for all 15 patients in that minimum oxygen saturation increased during sleep from an average preoperative minimum oxygen saturation of 58.7% to an average postoperative minimum oxygen saturation of 85.2%.

CONCLUSIONS

Bariatric surgery as a means of treating SAS in the morbidly obese provides effective long-term reduction in RDI. Bariatric surgery also significantly improves minimum oxygen saturation in morbidly obese patients with SAS. Biliopancreatic bypass is more effective in reducing RDI to normal values than vertical banded gastroplasty.

Tympanic membrane sensation

Sensation from the tympanic membrane is generally believed to be mediated via at least four cranial nerves, some authors describing discrete territories for each of these nerves. The lack of critical evidence for independent sensory areas prompted a clinical study of tympanic membrane sensation in 32 patients having known cranial nerve deficits. Tympanic membrane sensation was tested in four quadrants using a 300 mg bristle under a Zeiss operating microscope. The findings were highly suggestive of a predominantly nociceptive system. Any change relative to the opposite tympanum was usually anaesthesia. No complete trigeminal deficit retained perception in all tympanic quadrants. Facial, glossopharyngeal and vagal deficits alone never affected tympanic sensation. These findings support the trigeminal nerve as the principal sensory nerve to the tympanic membrane, supplemented only inconstantly and incompletely by the other cranial nerves.