Safety, pharmacokinetics, and target engagement of a brain penetrant RIPK1 inhibitor, SAR443820 (DNL788), in healthy adult participants

SAR443820 (DNL788) is a selective, orally bioavailable, brain penetrant inhibitor of receptor-interacting serine/threonine protein kinase 1 (RIPK1). This phase I first-in-human healthy participant study (NCT05795907) was comprised of three parts: randomized, double-blind, placebo-controlled single ascending dose (SAD; part 1a); 14-day multiple ascending dose (MAD; part 2) parts that evaluated safety, tolerability, pharmacokinetics (PK), and pharmacodynamics of SAR443820; and a separate open-label, single-dose part 1b (PK-cerebrospinal fluid [CSF]) to assess SAR443820 levels in CSF. SAR443820 was well-tolerated in healthy participants, and no treatment discontinuation related to an adverse event (AE) occurred. Most common AEs were dizziness and headache. No clinically meaningful changes were noted in laboratory values, vital signs, or electrocardiogram parameters. SAR443820 had a favorable PK profile, with plasma half-lives (geometric mean) ranged between 5.7-8.0 h and 7.2-8.9 h after single and repeated doses, respectively. There were no major deviations from dose proportionality for maximum concentration and area under the curve across SAR443820 doses. Mean CSF-to-unbound plasma concentration ratio ranged from 0.8 to 1.3 over time (assessed up to 10 h postdose), indicating high brain penetrance. High levels of inhibition of activated RIPK1, as measured by decrease in pS166-RIPK1, were achieved in both SAD and MAD parts, with a maximum median inhibition from baseline close to 90% at predose (Ctrough ) after multiple dosing in MAD, reflecting a marked RIPK1 target engagement at the peripheral level. These results support further development of SAR443820 in phase II trials in amyotrophic lateral sclerosis (NCT05237284) and multiple sclerosis (NCT05630547).

Pharmacokinetics of Alglucosidase Alfa Manufactured at the 4000-L Scale in Participants with Pompe Disease: A Phase 3/4 Open-Label Study

Pompe disease is a rare, autosomal recessive, degenerative neuromuscular disease caused by deficiency of acid α-glucosidase, a lysosomal enzyme that degrades α-1,4 and α-1,6 linkages in glycogen. The objectives of this study (PAPAYA; NCT01410890) were to (1) characterize the pharmacokinetics of 20 mg/kg body weight alglucosidase alfa manufactured at the 4000-L scale following a single intravenous dose in participants aged less than 18 and 18 years or older with Pompe disease and (2) evaluate the relationship between anti-alglucosidase alfa antibody titers and the pharmacokinetics of alglucosidase alfa. Mean maximum plasma concentration and area under the concentration-time curve from time zero and extrapolated to infinite time were 204 μg/mL and 1110 μg • h/mL for participants aged less than 18 years (n = 10), respectively, and 307 μg/mL and 1890 μg • h/mL for participants aged 18 years or older (n = 10), respectively. Mean terminal half-life was 5.43 hours in participants aged less than 18 years with a high variability (70%) and 3.84 hours in participants aged 18 years or older with a low variability (21%). Mean maximum plasma concentration and area under the concentration-time curve from time zero and extrapolated to infinite time were 256 μg/mL and 1452 μg • h/mL, respectively, in anti-alglucosidase alfa-negative participants (n = 12) and 262 μg/mL and 1703 μg • h/mL, respectively, in anti-alglucosidase alfa-positive participants (n = 7). The study findings enrich available data from existing information on alglucosidase alfa without changing its known risks and benefits.

Phase 1 study of oral selective estrogen receptor degrader (SERD) amcenestrant (SAR439859), in Japanese women with ER-positive and HER2-negative advanced breast cancer (AMEERA-2)

BACKGROUND

This AMEERA-2 study evaluated the pharmacokinetics, efficacy, and safety of the oral selective estrogen receptor degrader amcenestrant as a monotherapy with dose escalation in Japanese postmenopausal women with advanced estrogen receptor-positive and human epidermal growth factor receptor 2-negative breast cancer.

METHODS

In this open-label, nonrandomized, phase I study, patients received amcenestrant 400 mg once daily (QD) (n = 7) and 300 mg twice daily (BID) (n = 3). The incidence of dose-limiting toxicities (DLT), recommended dose, maximum tolerated dose (MTD), pharmacokinetics, efficacy, and safety were assessed.

RESULTS

No DLTs were observed and MTD was not reached in the 400 mg QD group. One DLT (grade 3 maculopapular rash) was reported in a patient treated with 300 mg BID. After repeated oral administration of either dosing regimen, steady state reached before day 8, without accumulation. Four out of 5 response-evaluable patients from 400 mg QD group achieved clinical benefit and showed tumor shrinkage. No clinical benefit was reported in the 300 mg BID group. Overall, most patients (8/10) experienced a treatment-related adverse event (TRAE), with skin and subcutaneous tissue disorders most commonly reported (4/10 patients). No ≥ grade 3 TRAE in 400 mg QD group and 1 grade 3 TRAE in 300 mg BID group were reported.

CONCLUSIONS

Amcenestrant 400 mg QD has a favorable safety profile and has been selected as the recommended Phase II dose for monotherapy for evaluating the safety and efficacy of amcenestrant in a larger, global, randomized clinical trial of patients with metastatic breast cancer.

TRIAL REGISTRATION

Clinical trial registration NCT03816839.

Interaction of a droplet spray with a turbulent plane air jet impacting a wall: Application to the confinement of atmospheres contaminated with particles by air curtain

Experiments are carried out to study the interaction of a spray of spherical micronic oil droplets with a turbulent plane air jet impacting a wall. The context is the separation of a contaminated atmosphere with passive particles from a clean atmosphere by using a dynamical air curtain. A spinning disk is used to produce the spray of oil droplets close to the air jet. The diameter of the produced droplets varies between 0.3 and 7 μ m. The jet and particulate Reynolds numbers and the jet and Kolmogorov-Stokes numbers are, respectively, equal to Re j = 13500 , 0.2 ≤ Re p ≤ 5 , 0.002 ≤ St j ≤ 0.8 and 0.03 ≤ St K ≤ 15 . The ratio of the jet height to nozzle width is H / e = 10 . The flow properties in the experiments are measured by particle image velocimetry and are in good agreement with large eddy simulation results. The droplet/particle passing rate (PPR) through the air jet is measured by an optical particle counter. The PPR decreases with the increase in the droplet diameter for the studied droplet size range. Whatever the droplet size is, the PPR increases with time due to the presence of two large vortices on each side of the air jet that bring the droplets back to the jet. The accuracy and repeatability of the measurements are verified. The present results can be used to validate Eulerian/Lagrangian numerical simulations on the interaction of micronic droplets with a turbulent air jet.

Simplified Modeling of Convection and Radiation Heat Transfer during Infrared Heating of PET Sheets and Preforms

Initial heating conditions and temperature effects have an important influence during the injection stretch blow molding process of PET preforms. The paper provides a simplified modeling of the infrared (IR) flux provided by the IR lamps and the convection heat transfer with air, for the finite element simulation of the heating of PET samples. This modeling enables fast thermal simulations in industrial context.

First, a complete 2D simulation of the air convection around a PET sheet sample is conducted using ANSYS/FLUENT to compute the local convection heat transfer coefficient. The distribution of this coefficient along the PET wall is then interpolated by a best linear fit function of the wall position to provide the boundary condition of the convection heat transfer thereafter. This boundary condition, coupled with the calculation of the infrared flux absorbed by the PET sheet sample, allows a 3D calculation of the time evolution of the sample temperature. This calculation is validated by comparing the experimental temperature distribution of the PET sheet obtained from an IR camera with the numerical results of the simulation. Second, we focus on the modeling of the heating of a cylindrical PET preforms by IR lamps. In our approach, the IR heating flux is calculated using the spectral and surfaceto-surface radiation laws adapted to the sample geometry. The air convection effect around the preform is modeled using the heat transfer coefficient identified from the 2D plane sheet case. It is applied on the boundaries of a simpler model in Comsol where only the preform is meshed. The temperature distribution on the outer surface of the preform is compared to experimental measurements by thermal imaging. A good agreement is observed which validates the whole approach used.

Crossing the Gulf of Aden: cutaneous infections in African migrant shipwreck survivors

Skin and soft tissue infections were observed in migrants from Somalia who crossed the Gulf of Aden, crowded on a drifting boat for 14 days. Thirty-three percent of survivors of this hazardous journey had skin infections. Seven were hospitalized for severe Staphylococcus aureus cutaneous infections associated with intracellular dehydration. Migrants face infectious risks during their precarious travel, including severe cutaneous infections that require specific medical and surgical treatment by the emergency services.

[Hemophagocytic syndrome due to Herpes simplex virus after hysteroscopy]

Hemophagocytic syndrome is an uncommon but life-threatening complication of Herpes simplex virus type 1 or 2 infection. Diagnosis is difficult to establish given the low specificity of clinical and biological signs.

[Medication reconciliation: an innovative experience in an internal medicine unit to decrease errors due to inacurrate medication histories]

PURPOSE

An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization. Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital. The aims of this prospective study were to evaluate the interest in clinical practice of this concept and the resources needed for its implementation.

METHODS

We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010. We obtained an accurate list of each patient's home medications. This list was then compared with medication orders. All medication variances were classified as intended or unintended. An internist and a pharmacist classified the clinical importance of each unintended variance.

RESULTS

Sixty-one patients (mean age: 78 ± 7.4 years) were included in our study. We identified 38 unintended discrepancies. The average number of unintended discrepancies was 0.62 per patient. Twenty-five patients (41%) had one or more unintended discrepancies at admission. The contact with the community pharmacist permitted us to identify 21 (55%) unintended discrepancies. The most common errors were the omission of a regularly used medication (76%) and an incorrect dosage (16%). Our intervention resulted in order changes by the physician for 30 (79%) unintended discrepancies. Fifty percent of the unintended variances were judged by the internist and 76% by the pharmacist to be clinically significant.

CONCLUSION

The admission to the hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories.

Staphylococcus simulans osteitis in a diabetic patient

Staphylococcus simulans was identified as the aetiological agent of osteitis in a diabetic woman. Its identifying characteristics and antibiogram were confirmed. Diabetic foot frequently becomes infected and the spread of infection to bone is a major causal factor behind lower-limb amputation. Early diagnosis and appropriate treatment are essential in such cases.

[Miliary cerebral Histoplasma capsulatum in an HIV-negative patient]

A 58 year-old man who lived in Africa for 17 years, presented, four years after returning to western France, acute confusion and weight loss. He had no fever and no immunosuppression. Clinical examination revealed Babinski sign, mucosal ulcerations of the mouth and hepatomegaly. The lumbar puncture revealed a meningitis and MRI showed a few parenchymal enhancing masses in the brain. Stereotaxic biopsies were performed. Specific culture and coloration were positive for the diagnosis of cerebral histoplasmosis. At the beginning, antifungal treatment with amphotericin B and itraconazole provided improvement. But seizures occurred and the treatment by carbamazepine induced decreased blood level of itraconazole. Despite itraconazole IV the patient died. This observation illustrates the difficulties in diagnosis and treatment of cerebral histoplasmosis and the various patterns of drug interactions.

[Skin and mucosal manifestations of chikungunya virus infection in adults in Reunion Island]

Numerous skin and mucosal manifestations were observed during the 2005-2006 chikungunya epidemic in Reunion Island. A prospective study was carried out in a consecutive series of 212 patients treated for chikungunya at the emergency unit of the Saint-Pierre Hospital in Reunion Island from March 8 to April 27, 2006. Diagnosis of chikungunya was suspected in patients with fever and joint pain and confirmed by RT-PCR and/or serology (IgM). Skin involvement was observed in 50% of patients. It consisted of exanthema with patches of healthy skin mainly on the trunk and limbs that sometimes displayed diffuse, congestive and even edematous features. Itching was reported in some cases (19.3%) and was sometimes isolated. Peeling of the skin was observed in a few cases but remained uncommon in adults. Outcome was rapidly favorable in most cases sometimes with scaling or persistence of dyschromic patches. These findings suggest that chikungunya should be suspected in subjects presenting a febrile rash while in an endemic areas or after returning from a tropical zone.

[Shigellosis or bacillary dysentery]

Shigellosis, commonly known as bacillary dysentery, is an enterobacterial disease caused by the Shigella genus, which now belongs to the Escherichia tribe, because of their genetic and phenotypic similarities. S. sonnei, flexneri, boydii and dysenteriae differ in their epidemiologic and pathogenic characteristics. S. sonnei is predominant in industrialized countries and causes the mildest disease. S. dysentery is especially dangerous because it occurs in outbreaks, sometimes in catastrophic situations, and has a high mortality rate. Shigellosis typically causes watery diarrhea followed by dysentery. It may be associated with a variety of mild to severe or even life-threatening complications. Shigellosis is a significant public health problem in developing countries where it remains a major cause of diarrhea-related morbidity and mortality, especially among children. Annual cases worldwide are estimated at 160 million. Shigellosis is a highly contagious disease of poor and crowded communities, with fecal-oral (hand-to-mouth) transmission, and an extremely low minimum infectious dose. Multidrug resistance is a serious problem. Ciprofloxacin is the first-line antibiotic, recommended for 3 days. Prevention and control should include personal hygiene, hand washing, sanitation, and water supply. No vaccine is available, but several candidates are currently being evaluated.

[Acute rhabdomyolysis and primary human immunodeficiency virus type 1 infection: a new observation]

INTRODUCTION

Acute human immunodeficiency virus type 1 infection is a clinical and biological misleading and often undiagnosed illness. Laboratory studies frequently demonstrate abnormalities. Acute rhabdomyolysis is rarely reported.

EXEGESIS

Authors report the case of an African man who presented with acute fever, cough, diarrhea, conjunctivitis, thrombocytopenia, lymphopenia, and rhabdomyolysis without other possible cause. HIV test and detection of plasma p24 antigen were initially negative but were controlled positive and associated with high level of viral RNA.

CONCLUSION

Symptomatic primary human immunodeficiency virus infection presenting with acute rhabdomyolysis was diagnosed. Diagnosis of primary HIV-1 infection must be considered in young people and patients at risk who present with acute rhabdomyolysis and fever.

Streptococcus pyogenes : une cause exceptionnelle d'urétrite et de balanite non gonococcique de l'adulte

Urethritis and balanitis due to S. pyogenes are very uncommon. The authors report the case of a 22 year-old male patient, presenting with this association, the first case reported in France. There was no associated STD.

[Asymptomatic forms of the Severe Acute Respiratory Syndrome (SARS)]

Introduction

Une épidémie de pneumopathies atypiques est apparue en novembre 2002 dans la région Chinoise de Guangdong. Elle a ensuite été décrite sous le nom de syndrome respiratoire aigu sévère (SRAS) à partir de nouveaux foyers survenus à Hanoi et à Hong Kong en février 2003. En France, 5 cas reliés au même patient source ont été rapportés.

Observation

Nous rapportons l’observation d’un patient de 52 ans contact direct avec un cas probable de SRAS. À l’admission, le patient présente une hyperthermie isolée sans symptomatologie respiratoire associée à une lymphopénie et une cytolyse hépatique. La radiographie thoracique est normale. La tomodensitométrie thoracique objective l’existence d’un aspect en verre dépoli sous pleural. L’étude par PCR des prélèvements naso-pharyngés précoces (36^e heure) à la recherche du coronavirus associé au SARS sera négative. La confirmation du cas sera obtenue par l’étude sérologique.

Conclusions

Cette observation illustre l’existence de présentations cliniques frustres du syndrome respiratoire aigu sévère. La contagiosité des formes pauci symptomatiques n’est pas connue. Des analyses sérologiques permettront de mieux les préciser. Le danger actuel d’une recrudescence saisonnière particulièrement hivernale ne peut être écarté. Dans ce contexte, l’existence et la reconnaissance des formes pauci symptomatiques pour lesquelles la contagiosité ne peut être écartée est primordiale.

[Bacteremia and pneumonia due to Yersinia enterocolitica serotype O:3 in an immunocompetent patient]

The authors report a rare case of Yersinia enterocolitica O:3 pneumonia in an immunocompetent 70-year old man. There was no evidence of acute gastrointestinal disease. Diagnosis was confirmed by blood cultures. He responded with resolution of the infection after 21 days of therapy with a third-generation cephalosporin then by cotrimoxazole. Only 15 cases have been reported so far. Most of the patients were immunocompromised. This is the first case in France.

Ascite par péricardite constrictive

INTRODUCTION

We report a case in which ascites revealed chronic constrictive pericarditis (CCP) of tuberculous origin.

OBSERVATION

A 65 year-old man had developed ascites the past over few weeks and oedema of the lower limbs. Treatment was surgical and consisted in pericardiectomy.

DISCUSSION

Chronic constrictive pericarditis has become rare in industrialised countries with the reduction in the incidence of tuberculosis. Currently, its principle aetiologies identified are previous cardiac surgery and radiotherapy. Treatment is usually surgical and gives excellent results. This clinical case clearly illustrates the interest of systematic biological analysis of ascites, since it may reveal a curable disease.

[Acute encephalitis concurrent with primary infection by Schistosoma mansoni]

A 24-year-old man returning from a trip to Mali was hospitalized for acute encephalitis and fever in association with acute primary infection by Schistosomiasis mansoni. Bilharziasis was suspected from the epidemiological context and presence of eosinophilia. Diagnosis was confirmed by serological testing. Specific treatment using praziquantel and corticotherapy was successful. Central nervous system involvement attributable to embolization of eggs or ectopic migration of adult worms has been reported in association with chronic Schistosomiasis by S. japonicum or S. mansoni. There have been few reports of acute neuroschistosomiais during the acute primary phase of infestation by S. mansoni. Etiology probably involves immunoallergic mechanisms.