Allergen Delivery Inhibitors: Characterisation of Potent and Selective Inhibitors of Der p 1 and Their Attenuation of Airway Responses to House Dust Mite Allergens

Group 1 allergens of house dust mites (HDM) are globally significant triggers of allergic disease. They are considered as initiator allergens because their protease activity enables the development of allergy to a spectrum of unrelated allergens from various sources. This initiator-perpetuator function identifies Group 1 HDM allergens as attractive drug design targets for the first small-molecule approach directed towards a non-human, root cause trigger of allergic disease. The purpose of this study was to: (i) identify exemplar inhibitors of these allergens using Der p 1 as a design template, and (ii) characterise the pharmacological profiles of these compounds using in vitro and in vivo models relevant to allergy. Potent inhibitors representing four different chemotypes and differentiated by mechanism of action were investigated. These compounds prevented the ab initio development of allergy to the full spectrum of HDM allergens and in established allergy they inhibited the recruitment of inflammatory cells and blunted acute allergic bronchoconstriction following aerosol challenge with the full HDM allergen repertoire. Collectively, the data obtained in these experiments demonstrate that the selective pharmacological targeting of Der p 1 achieves an attractive range of benefits against exposure to all HDM allergens, consistent with the initiator-perpetuator function of this allergen.

Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution

Background

Post-discharge surgical site infections (SSI) are a major source of morbidity, expense and anxiety for patients. However, patient perceptions about barriers experienced while seeking care for post-discharge SSI have not been assessed in depth. We explored patient experience of SSI and openness to a mobile health (mHealth) wound monitoring “app” as a novel solution to address this problem.

Methods

Mixed method design with semi-structured interviews and surveys. Participants were patients who had post-discharge surgical wound complications after undergoing operations with high risk of SSI, including open colorectal or ventral hernia repair surgery. The study was conducted at two affiliated teaching hospitals, including an academic medical center and a level 1 trauma center.

Results

From interviews with 13 patients, we identified 3 major challenges that impact patients' ability to manage post-discharge surgical wound complications, including required knowledge for wound monitoring from discharge teaching, self-efficacy for wound monitoring at home, and accessible communication with their providers about wound concerns. Patients found an mHealth wound monitoring application highly acceptable and articulated its potential to provide more frequent, thorough, and convenient follow-up that could reduce post-discharge anxiety compared to the current practice. Major concerns with mHealth wound monitoring were lack of timely response from providers and inaccessibility due to either lack of an appropriate device or usability challenges.

Conclusions

Our findings reveal gaps and frustrations with post-discharge care after surgery which could negatively impact clinical outcomes and quality of life. To address these issues, we are developing mPOWEr, a patient-centered mHealth wound monitoring application for patients and providers to collaboratively bridge the care transition between hospital and home.

The discovery of potent, selective, and reversible inhibitors of the house dust mite peptidase allergen Der p 1: an innovative approach to the treatment of allergic asthma

Blocking the bioactivity of allergens is conceptually attractive as a small-molecule therapy for allergic diseases but has not been attempted previously. Group 1 allergens of house dust mites (HDM) are meaningful targets in this quest because they are globally prevalent and clinically important triggers of allergic asthma. Group 1 HDM allergens are cysteine peptidases whose proteolytic activity triggers essential steps in the allergy cascade. Using the HDM allergen Der p 1 as an archetype for structure-based drug discovery, we have identified a series of novel, reversible inhibitors. Potency and selectivity were manipulated by optimizing drug interactions with enzyme binding pockets, while variation of terminal groups conferred the physicochemical and pharmacokinetic attributes required for inhaled delivery. Studies in animals challenged with the gamut of HDM allergens showed an attenuation of allergic responses by targeting just a single component, namely, Der p 1. Our findings suggest that these inhibitors may be used as novel therapies for allergic asthma.

Lupus anticoagulant in anti-neutrophil cytoplasmic antibody-associated polyarteritis

Lupus anticoagulant has been described in association with many autoimmune disorders. Here we describe its occurrence in a patient with ANCA-associated microscopic polyarteritis with medium vessel involvement. A 62-year-old man presented with mononeuritis multiplex and abdominal pain and was demonstrated to have multiple aneurysms on visceral angiography, consistent with the diagnosis of medium vessel vasculitis or classical polyarteritis nodosa. In addition he had active tuberculosis. He developed a deep venous thrombosis at this admission and, on one occasion, had a prolonged APTT but this was not confirmed to be due to a lupus anticoagulant. Two years later when the patient was readmitted with fevers, headaches and nasal discharge, both ANCA and a lupus anticoagulant were demonstrated in his serum, although there was no evidence of a venous thrombosis. Six months later the patient was demonstrated for the first time to have dysmorphic urinary RBC consistent with glomerular bleeding; at the same time he developed a deep venous thrombosis. ANCA was still present, but the lupus anticoagulant could not be detected. The patient was treated with cyclophosphamide and prednisolone and a Greenfield filter inserted into his inferior vena cava.

Atypical fibroxanthoma: two unusual variants

Two unusual fibroxanthomas were studied by light microscopy. The first case contained numerous osteoclast-like cells and resembled malignant giant cell tumour of soft tissues, a variant of malignant fibrous histiocytoma. Osteoclast-like giant cells were negative for lysozyme and alpha-1-antitrypsin. The second case contained areas of chondroid differentiation which resembled chondrosarcoma. Tumour cells within the cartilaginous areas were positive for S100 protein.

Detection and follow-up of moderate and severe hypertensive subjects in the Australia community

A national screening project has detected 989 subjects aged 30 to 69 years with untreated moderate or severe hypertension. The 1-2% incidence of this condition indicates a total of about 100,000 people in the Australian community potentially requiring therapy. The sample showed that half the subjects were previously unaware of a blood pressure problem. Those so detected showed a very high rate (90-7%) of acceptance of advice to see their own doctor. The local doctors confirmed the elevated pressure level in nearly two-thirds of the patients referred, and initiated treatment in a similar proportion.

Report on progress in the Australian National Blood Pressure Study (NBPS)

1. The National Blood Pressure Study (NBPS) is a single blind trial designed to test the efficacy of active drug treatment in reducing complications from mild hypertension (mean diastolic pressure = 95-109 mmHg). 2. Between 1973 and 1975, four centres screened about 104 000 subjects aged 30-69 years, yielding an estimated prevalence of hypertension (greater than or equal to 95 mmHg diastolic) of 16% and of moderate-to-severe hypertension (greater than of equal to 110 mmHg diastolic) of 1-3%. 3. Some 4000 subjects selected for untreated uncomplicated mild hypertension were randomized to either active treatment (cholorothiazide +alpha-methyldopa and/or a beta-adrenoreceptor antagonist as required) or to matching placebos. 4. At 1 year mean pressures had fallen significantly below entry pressures in both groups but in the active group the fall was greater by a margin of 14-4+/-1-3 (SEM) mmHg systolic and 7-1+/-0-7 mmHg diastolic. At 1 year 5% of subjects in the placebo group had been placed on active treatment on the ethical grounds that pressure had exceeded the mild hypertension limit. 5. Trial end-points (death, morbidity from stroke, hypertensive heart and renal disease, and ischaemic heart disease) number 106 (nine deaths) thus far, of which ischaemic heart disease accounts for 71% and stroke 19%. 6. The duration of trial may need to be extended beyond the original estimate of 5 years.

Conflicting motion perspective simulating sinultaneous clockwise and counterclockwise rotation in depth

Motion projections (pictures) simulating a horizontal array of vertical lines rotating in depth about its central vertical line were observed by 24 college students who rotated a crank handle in the direction of apparent rotation. All displays incorporated contradictory motion perspective: Whereas the perspective transformation in the vertical (y) dimension stimulated one direction of rotation, the transformation in the horizontal (x) dimension simulated the opposite direction. The amount of perspective in each dimension was varied independently of the other by varying the projection ratio used for each dimension. We used the same five ratios for each dimension, combining them factorially to generate the 25 displays. Analysis of variance of the duration of crank turning which agreed with y-axis information yielded main effects of both x and y projection ratios but no interaction, revealing that x- and y-axis motion perspectives mediate kinetic depth effects which are functionally independent.

Conflicting motion perspective simulating simultaneous clockwise and counterclockwise rotation in depth

Motion projections (pictures) simulating a horizontal array of vertical lines rotating in depth about its central vertical line were observed by 24 college students who rotated a crank handle in the direction of apparent rotation. All displays incorporated contradictory motion perspective: Whereas the perspective transformation in the vertical (y) dimension stimulated one direction of rotation, the transformation in the horizontal (x) dimension simulated the opposite direction. The amount of perspective in each dimension was varied independently of the other by varying the projection ratio used for each dimension. We used the same five ratios for each dimension, combining them factorially to generate the 25 displays. Analysis of variance of the duration of crank turning which agreed with y-axis information yielded main effects of both x and y projection ratios but no interaction, revealing that x- and y-axis motion perspectives mediate kinetic depth effects which are functionally independent.