Comparison of first-line and second-line use of fingolimod in relapsing MS: The open-label EARLIMS study

Background

Treatment of MS often begins with low-efficacy injectable disease-modifying therapy (iDMT).

Objectives

To compare the effect of fingolimod 0.5 mg/day on clinical, MRI, patient-reported, and safety outcomes, in treatment-naïve and previously treated (≥1 iDMT) patients with early MS.

Methods

EARLIMS was a multicentre, open-label, non-randomized, parallel-group phase 3 b/4 study in Australia and Spain. Patients with relapsing–remitting MS, Expanded Disability Status Scale (EDSS) score <4.0, and ≥1–5 years since diagnosis, received daily fingolimod for 48 weeks. The primary endpoint was annualized relapse rate (ARR).

Results

Of 347 patients enrolled at 51 sites (treatment-naïve, 200 [57.6%]; previously treated, 147 [42.4%]), 320 completed the study (treatment-naïve, 184 [92.0%]; previously treated, 136 [92.5%]), but the study remained underpowered (planned enrolment, n = 432). Fingolimod reduced ARR to similar levels in both treatment-naïve (mean ARR [95% confidence interval], 0.21 [0.14, 0.29]) and previously treated groups (0.30 [0.20, 0.41]; p = 0.1668). There were no new safety signals.

Conclusions

Fingolimod appeared equally effective as first- or second-line therapy in relapsing MS. There was a trend for better outcomes with fingolimod in treatment-naïve patients than in those previously treated with >1 iDMT.

Natalizumab Modifies Catecholamines Levels Present in Patients with Relapsing- Remitting Multiple Sclerosis

AIMS

The main aim of this study was to verify the effect of natalizumab on the levels of circulating catecholamines and indolamine and their possible relation with MS.

METHODS

For this purpose, 12 healthy individuals (control group) and 12 relapsing-remitting multiple sclerosis patients (RR-MS) were selected. The patients were treated with 300 mg of natalizumab during 56 weeks (1 dose/4 weeks) (MS-56). This selection was based on the McDonalds revision criterion and scheduled to star treatment with natalizumab. Blood samples were taken before treatment (basal level) and after 56 weeks of using natalizumab. Melatonin was measured in serum and in plasma, catecholamines (dopamine, epinephrine, and norepinephrine), carbonylated proteins, 8-hydroxy-2'deoxyguanosine (8OH-dG) and the ratio reduced glutathione/oxidised glutathione (GSH/GSSG).

RESULTS

The epinephrine and dopamine levels diminished in the basal group with respect to the control and did not recover normal levels with the treatment. The melatonin was decreased in RR-MS patients and went back to its normal levels with natalizumab. Norepinephrine was increased in RR-MS and decreased in MS-56 until it equalled the control group.

CONCLUSION

Natalizumab normalizes altered melatonin and norepinephrine levels in MS.

The use of biomarkers for the etiologic diagnosis of MCI in Europe: an EADC survey

We investigated the use of Alzheimer's disease (AD) biomarkers in European Alzheimer's Disease Consortium centers and assessed their perceived usefulness for the etiologic diagnosis of mild cognitive impairment (MCI). We surveyed availability, frequency of use, and confidence in diagnostic usefulness of markers of brain amyloidosis (amyloid positron emission tomography [PET], cerebrospinal fluid [CSF] Aβ42) and neurodegeneration (medial temporal atrophy [MTA] on MR, fluorodeoxyglucose positron emission tomography [FDG-PET], CSF tau). The most frequently used biomarker is visually rated MTA (75% of the 37 responders reported using it "always/frequently") followed by CSF markers (22%), FDG-PET (16%), and amyloid-PET (3%). Only 45% of responders perceive MTA as contributing to diagnostic confidence, where the contribution was rated as "moderate". Seventy-nine percent of responders felt "very/extremely" comfortable delivering a diagnosis of MCI due to AD when both amyloid and neuronal injury biomarkers were abnormal (P < .02 versus any individual biomarker). Responders largely agreed that a combination of amyloidosis and neuronal injury biomarkers was a strongly indicative AD signature.

Dynamics and quantitative analysis of the synthesis of fermentative aromas by an evolved wine strain of Saccharomyces cerevisiae

We performed a dynamic and quantitative analysis of the synthesis of fermentative aromas by an aromatic wine yeast, ECA5, obtained by adaptive evolution. During fermentation at pilot scale on synthetic and natural musts, ECA5 produced volatile compounds (higher alcohols and their acetates, ethyl esters) at higher rates than the ancestral strain, with the exception of propanol. Marked differences in the chronology of synthesis of several compounds were observed between the two strains. Overproduction of phenyl ethanol occurred mainly during the growth phase for ECA5, consistent with its higher flux through the pentose phosphate pathway, which plays a key role in biosynthetic processes. The kinetics of production of isobutanol and isoamyl alcohol were differently affected by different media (synthetic or natural must) and, in particular, according to the nature of the sterols in the media (ergosterol or phytosterols). We also observed differences in the chronology of synthesis of ethyl acetate and isoamyl acetate or ethyl esters, suggesting that the regulation of the synthesis of these compounds in the evolved strain differs from that in the ancestral strain. This study shows that a dynamic analysis of volatile compounds, using high acquisition frequency online gas chromatography, can provide novel insights into the synthesis and regulation of aromas and is thus a potentially powerful tool for strain characterization.

[Natalizumab and reduction of carbonylated proteins in patients with multiple sclerosis]

INTRODUCTION

The sensitivity of the central nervous system to oxidative damage and its relationship with inflammatory response are well known. Recent studies have shown that oxidative stress is present in the establishment and development of multiple sclerosis (MS). One of the most recent treatments in this process is natalizumab, a monoclonal antibody.

AIM

To evaluate whether the therapeutic effect of natalizumab is associated with the severity of the disease and the oxidative damage.

PATIENTS AND METHODS

Researchers recruited twenty patients with relapsing-remitting MS (RRMS) undergoing therapy with natalizumab and distributed, according to the Expanded Disability Status Scale (EDSS), in two groups: RRMS-1 (EDSS < 5) and RRMS-2 (EDSS ≥ 5). Blood samples were taken for an oxidative profile study.

RESULTS

Data showed a decrease in carbonylated proteins following treatment with natalizumab. The reduction in oxidative damage rated as protein oxidation is significant between the previous (baseline) situation of the patient and after 14 months' treatment. The most significant decrease coincided with the patients with the highest levels of severity in the process. Although it has not been possible to establish a correlation, the statistical significance is higher for patients in the RRMS-2 group treated with natalizumab. The antioxidant systems, on the other hand, did not display any statistically significant changes.

CONCLUSIONS

Natalizumab brings about a reduction in carbonylated protein levels.

The rate of CO(2) assimilation controls the expression and activity of glutamine synthetase through sugar formation in sunflower (Helianthus annuus L) leaves

The expression and activity of glutamine synthetase (GS, EC 6.3.1.2) were examined in relation to the rate of CO2 assimilation in sunflower (Helianthus annuus L.) leaves. Intact plants were kept in the dark for 72 h and subsequently exposed to light under different atmospheric CO2 concentrations (100, 400 and 1200 microl l-1) for 6 h. The in vivo rates of net CO2 assimilation correlated with atmospheric CO2 concentrations. Stomatal conductances and transpiration rates remained largely unaffected by CO2 levels. Exposure of the plants to increasing CO2 concentrations in the light caused concomitant increases in the contents of starch and soluble sugars and a decrease in the nitrate content in leaves. Both cytosolic and chloroplastic (GS2) GS activities were higher at elevated CO2. A greater accumulation of GS2 mRNA was also observed under high CO2. Exogenous supply of sucrose to detached leaves greatly increased the levels of GS enzyme activity and of mRNA for chloroplastic GS in the dark. These results indicate that GS expression and activity in sunflower leaves are modulated by the rate of CO2 assimilation, and that photosynthesized sugars are presumably involved as regulatory metabolites.

Muscle fibre type composition in untrained and endurance-trained Andalusian and Arab horses

Muscle biopsies were taken from the middle gluteal muscle of 68 stallions (52 Andalusian [AN] and 16 Arab [AR]) ranging from six to 12 years of age. Seventeen AN horses and eight AR horses were untrained, while the remainder underwent active endurance training for 6 months. Fifteen AN horses were moderately endurance-trained while the other 20 AN horses and eight AR horses were strongly endurance-trained. Percentages of type I and type II fibres were similar in all groups (P greater than 0.05). The group of horses with the hardest training had a higher percentage of type IIA fibres (AN P less than 0.01; AR P less than 0.02) and a lower percentage of type IIB fibres (P less than 0.05 for AN and AR) than the untrained horses. All trained horses had a higher percentage of type IIB oxidative fibres and a lower percentage of type IIB non-oxidative fibres than the untrained horses (P less than 0.01 for both). These results suggest that the proportions of type I and type II fibres are highly stable within a given breed, but the stimulus of training facilitates changes both in contractile properties and, particularly, in the oxidative capacity of type II subgroups.

Differences in fibre population in dog muscles of different functional purpose

Samples were taken from particular sites of the tibialis cranialis (extensor), flexor digitalis medialis (flexor) and pectineus (adductor) muscles of 27 dogs of different breeds--German shepherd, Spanish greyhound, Spanish mastiff and Iberian hound. Samples, which were taken from right and left limbs, were subjected to histochemical analysis using ATPase (pH 9.4, 4.6 and 4.2) and NADH-tr. Fibre population was assessed using an IBAS-2 Kontron image analyser.