1
|
Vrouwe JPM, Meulenberg JJM, Klarenbeek NB, Navas-Cañete A, Reijnierse M, Ruiterkamp G, Bevaart L, Lamers RJ, Kloppenburg M, Nelissen RGHH, Huizinga TWJ, Burggraaf J, Kamerling IMC. Administration of an adeno-associated viral vector expressing interferon-β in patients with inflammatory hand arthritis, results of a phase I/II study. Osteoarthritis Cartilage 2022; 30:52-60. [PMID: 34626797 DOI: 10.1016/j.joca.2021.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Inflammatory hand arthritis (IHA) results in impaired function. Local gene therapy with ART-I02, a recombinant adeno-associated virus (AAV) serotype 5 vector expressing interferon (IFN)-β, under the transcriptional control of nuclear factor κ-B responsive promoter, was preclinically shown to have favorable effects. This study aimed to investigate the safety and tolerability of local gene therapy with ART-I02 in patients with IHA. METHODS In this first-in-human, dose-escalating, cohort study, 12 IHA patients were to receive a single intra-articular (IA) injection of ART-I02 ranging 0.3 × 1012-1.2 × 1013 genome copies in an affected hand joint. Adverse events (AEs), routine safety laboratory and the clinical course of disease were periodically evaluated. Baseline- and follow-up contrast enhanced magnetic resonance images (MRIs), shedding of viral vectors in bodily fluids, and AAV5 and IFN-β immune responses were evaluated. A data review committee provided safety recommendations. RESULTS Four patients were enrolled. Long-lasting local AEs were observed in 3 patients upon IA injection of ART-I02. The AEs were moderate in severity and could be treated conservative. Given the duration of the AEs and their possible or probable relation to ART-I02, no additional patients were enrolled. No systemic treatment emergent AEs were observed. The MRIs reflected the AEs by (peri)arthritis. No T-cell response against AAV5 or IFN-β, nor IFN-β antibodies could be detected. Neutralizing antibody titers against AAV5 raised post-dose. CONCLUSION Single IA doses of 0.6 × 1012 or 1.2 × 1012 ART-I02 vector genomes were administered without systemic side effects or serious AEs. However, local tolerability was insufficient for continuation. TRIAL REGISTRATION NCT02727764.
Collapse
Affiliation(s)
- J P M Vrouwe
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center (LUMC), Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - J J M Meulenberg
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - N B Klarenbeek
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center, Department of Internal Medicine, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - A Navas-Cañete
- Leiden University Medical Center, Department of Radiology, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands.
| | - M Reijnierse
- Leiden University Medical Center, Department of Radiology, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - G Ruiterkamp
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - L Bevaart
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - R J Lamers
- Department of Oncology, Arthrogen B.V., Meibergdreef 45, Amsterdam, 1005BA, the Netherlands
| | - M Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Department of Orthopaedics, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - T W J Huizinga
- Leiden Academic Centre for Drug Research, PO box 9500, Leiden, 2300 RA, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center, Department of Internal Medicine, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands; Leiden Academic Centre for Drug Research, PO box 9500, Leiden, 2300 RA, the Netherlands
| | - I M C Kamerling
- Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333 CL, the Netherlands; Leiden University Medical Center, Department of Infectious Diseases, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands.
| |
Collapse
|
2
|
Vrouwe J, Burggraaf J, Kloppenburg M, Stuurman F. Challenges and opportunities of pharmacological interventions for osteoarthritis: A review of current clinical trials and developments. Osteoarthritis and Cartilage Open 2021; 3:100212. [DOI: 10.1016/j.ocarto.2021.100212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/17/2023] Open
|
3
|
van der Wall HEC, Doll RJ, van Westen GJP, Koopmans I, Zuiker RG, Burggraaf J, Cohen AF. Using machine learning techniques to characterize sleep-deprived driving behavior. Traffic Inj Prev 2021; 22:366-371. [PMID: 33960857 DOI: 10.1080/15389588.2021.1914837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Sleep deprivation is known to affect driving behavior and may lead to serious car accidents similar to the effects from e.g., alcohol. In a previous study, we have demonstrated that the use of machine learning techniques allows adequate characterization of abnormal driving behavior after alprazolam and/or alcohol intake. In the present study, we extend this approach to sleep deprivation and test the model for characterization of new interventions. We aimed to classify abnormal driving behavior after sleep deprivation, and, by using a machine learning model, we tested if this model could also pick up abnormal driving behavior resulting from other interventions. METHODS Data were collected during a previous study, in which 24 subjects were tested after being sleep-deprived and after a well-rested night. Features were calculated from several driving parameters, such as the lateral position, speed of the car, and steering speed. In the present study, we used a gradient boosting model to classify sleep deprivation. The model was validated using a 5-fold cross validation technique. Next, probability scores were used to identify the overlap of driving behavior after sleep deprivation and driving behavior affected by other interventions. In the current study alprazolam, alcohol, and placebo are used to test/validate the approach. RESULTS The sleep deprivation model detected abnormal driving behavior in the simulator with an accuracy of 77 ± 9%. Abnormal driving behavior after alprazolam, and to a lesser extent also after alcohol intake, showed remarkably similar characteristics to sleep deprivation. The average probability score for alprazolam and alcohol measurements was 0.79, for alcohol 0.63, and for placebo only 0.27 and 0.30, matching the expected relative drowsiness. CONCLUSION We developed a model detecting abnormal driving induced by sleep deprivation. The model shows the similarities in driving characteristics between sleep deprivation and other interventions, i.e., alcohol and alprazolam. Consequently, our model for sleep deprivation may serve as a next reference point for a driving test battery of newly developed drugs.
Collapse
Affiliation(s)
- H E C van der Wall
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | - R J Doll
- Centre for Human Drug Research, Leiden, the Netherlands
| | - G J P van Westen
- Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | - I Koopmans
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Center, Leiden, the Netherlands
| | - R G Zuiker
- Centre for Human Drug Research, Leiden, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden Academic Centre for Drug Research, Leiden, the Netherlands
- Leiden University Medical Center, Leiden, the Netherlands
| | - A F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden Academic Centre for Drug Research, Leiden, the Netherlands
- Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
4
|
Achterberg FB, Deken MM, Meijer RPJ, Mieog JSD, Burggraaf J, van de Velde CJH, Swijnenburg RJ, Vahrmeijer AL. Clinical translation and implementation of optical imaging agents for precision image-guided cancer surgery. Eur J Nucl Med Mol Imaging 2021; 48:332-339. [PMID: 32783112 PMCID: PMC7835299 DOI: 10.1007/s00259-020-04970-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The field of tumor-specific fluorescence-guided surgery has seen a significant increase in the development of novel tumor-targeted imaging agents. Studying patient benefit using intraoperative fluorescence-guided imaging for cancer surgery is the final step needed for implementation in standard treatment protocols. Translation into phase III clinical trials can be challenging and time consuming. Recent studies have helped to identify certain waypoints in this transition phase between studying imaging agent efficacy (phase I-II) and proving patient benefit (phase III). TRIAL INITIATION Performing these trials outside centers of expertise, thus involving motivated clinicians, training them, and providing feedback on data quality, increases the translatability of imaging agents and the surgical technique. Furthermore, timely formation of a trial team which oversees the translational process is vital. They are responsible for establishing an imaging framework (camera system, imaging protocol, surgical workflow) and clinical framework (disease stage, procedure type, clinical research question) in which the trial is executed. Providing participating clinicians with well-defined protocols with the aim to answer clinically relevant research questions within the context of care is the pinnacle in gathering reliable trial data. OUTLOOK If all these aspects are taken into consideration, tumor-specific fluorescence-guided surgery is expected be of significant value when integrated into the diagnostic work-up, surgical procedure, and follow-up of cancer patients. It is only by involving and collaborating with all stakeholders involved in this process that successful clinical translation can occur. AIM Here, we discuss the challenges faced during this important translational phase and present potential solutions to enable final clinical translation and implementation of imaging agents for image-guided cancer surgery.
Collapse
Affiliation(s)
- F B Achterberg
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M M Deken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - R P J Meijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research (CHDR), Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - R J Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
5
|
van der Wall HEC, Doll RJ, van Westen GJP, Koopmans I, Zuiker RG, Burggraaf J, Cohen AF. The use of machine learning improves the assessment of drug-induced driving behaviour. Accid Anal Prev 2020; 148:105822. [PMID: 33125924 DOI: 10.1016/j.aap.2020.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
RATIONALE Car-driving performance is negatively affected by the intake of alcohol, tranquillizers, sedatives and sleep deprivation. Although several studies have shown that the standard deviation of the lateral position on the road (SDLP) is sensitive to drug-induced changes in simulated and real driving performance tests, this parameter alone might not fully assess and quantify deviant or unsafe driving. OBJECTIVE Using machine learning we investigated if including multiple simulator-derived parameters, rather than the SDLP alone would provide a more accurate assessment of the effect of substances affecting driving performance. We specifically analysed the effects of alcohol and alprazolam. METHODS The data used in the present study were collected during a previous study on driving effects of alcohol and alprazolam in 24 healthy subjects (12 M, 12 F, mean age 26 years, range 20-43 years). Various driving features, such as speed and steering variations, were quantified and the influence of administration of alcohol or alprazolam was assessed to assist in designing a predictive model for abnormal driving behaviour. RESULTS Adding additional features besides the SDLP increased the model performance for prediction of drug-induced abnormal driving behaviour (from an accuracy of 65 %-83 % after alprazolam intake and from 50 % to 76 % after alcohol ingestion). Driving behaviour influenced by alcohol and alprazolam was characterised by different feature importance, indicating that the two interventions influenced driving behaviour in a different way. CONCLUSION Machine learning using multiple driving features in addition to the state-of-the-art SDLP improves the assessment of drug-induced abnormal driving behaviour. The created models may facilitate quantitative description of abnormal driving behaviour in the development and application of psychopharmacological medicines. Our models require further validation using similar and unknown interventions.
Collapse
Affiliation(s)
- H E C van der Wall
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden Academic Centre for Drug Research, Leiden, the Netherlands.
| | - R J Doll
- Centre for Human Drug Research, Leiden, the Netherlands
| | - G J P van Westen
- Leiden Academic Centre for Drug Research, Leiden, the Netherlands
| | - I Koopmans
- Centre for Human Drug Research, Leiden, the Netherlands
| | - R G Zuiker
- Centre for Human Drug Research, Leiden, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden Academic Centre for Drug Research, Leiden, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| | - A F Cohen
- Centre for Human Drug Research, Leiden, the Netherlands; Leiden Academic Centre for Drug Research, Leiden, the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
6
|
Hassing G, Fienieg B, Van Der Wall H, Van Westen G, Kemme M, Adiyaman A, Elvan A, Burggraaf J, Gal P. The association between body temperature and electrocardiographic parameters in normothermic healthy volunteers. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Previous studies have observed that hypo- and hyperthermia are associated with several atrial and ventricular electrocardiographical parameters, including the corrected QT interval. Preclinical studies have shown that drugs that exert an effect on body temperature also exert an effect on the corrected QT interval. Therefore, increased characterization in healthy humans of the association between the corrected QT interval and body temperature within the normal body temperature range aids in understanding the mechanism behind drug induced corrected QT interval effects. The objective of this analysis was to evaluate the association between body temperature and electrocardiographical parameters in normothermic healthy volunteers.
Methods
Data from 3023 volunteers collected at our center were analyzed. Only subjects considered healthy after review of collected data by a physician, including a normal tympanic body temperature (35.5–37.5 °C) and in sinus rhythm, were included in the analysis. Subjects were divided into body temperature quartiles for analysis and a linear multivariate model with body temperature as a continuous was performed. Another multivariate analysis was performed with only the QT subintervals as independent variables and body temperature as dependent variable.
Results
Mean age was 33.8±17.5 years and mean body temperature was 36.6±0.4 °C. Body temperature was independently associated with age (standardized coefficient (SC)=−0.252, P<0.001), gender (SC=+0.208, P<0.001), heart rate (SC=+0.230, P<0.001), J-point elevation in lead V4 (SC=−0.118, P<0.001), and Fridericia corrected QT interval (SC=−0.061, P=0.002). Atrial and AV nodal parameters were not independently associated with body temperature. The effects of temperature on the surface ECG are displayed in figure 1. QT subinterval analysis revealed that only QRS duration (SC=−0.121, P<0.001) was independently associated with body temperature.
Conclusion
Body temperature in normothermic healthy volunteers was associated with heart rate, J-point amplitude in lead V4 and ventricular conductivity, primarily through a prolongation of the QRS duration. In contrast, atrial and AV nodal ECG parameters were not independently associated with body temperature.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- G.J Hassing
- Centre for Human Drug Research, Leiden, Netherlands (The)
| | - B Fienieg
- Independent, Arnhem, Netherlands (The)
| | | | - G.J.P Van Westen
- Leiden Academic Center for Drug Researh, Leiden, Netherlands (The)
| | - M.J.B Kemme
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - A Adiyaman
- Isala Hospital, Zwolle, Netherlands (The)
| | - A Elvan
- Isala Hospital, Zwolle, Netherlands (The)
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands (The)
| | - P Gal
- Centre for Human Drug Research, Leiden, Netherlands (The)
| |
Collapse
|
7
|
Rijsbergen M, Niemeyer‐van der Kolk T, Rijneveld R, Pinckaers J, Meshcheriakov I, Bouwes Bavinck J, van Doorn M, Hogendoorn G, Feiss G, Cohen A, Burggraaf J, van Poelgeest M, Rissmann R. Mobile e-diary application facilitates the monitoring of patient-reported outcomes and a high treatment adherence for clinical trials in dermatology. J Eur Acad Dermatol Venereol 2020; 34:633-639. [PMID: 31419338 PMCID: PMC7064941 DOI: 10.1111/jdv.15872] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Assessment of treatment effects in clinical trials requires valid information on treatment adherence, adverse events and symptoms. Paper-based diaries are often inconvenient and have limited reliability, particularly for outpatient trials. OBJECTIVES To investigate the utility of an electronic diary (e-diary) application for patients with skin diseases in outpatient clinical trials. METHODS An e-diary application was developed and technically validated. Treatment adherence was defined as topical administration by the patient, and patient-reported outcomes, i.e. pain and itch, were evaluated by the e-diary in six clinical trials on newly tested topical drugs. Additionally, the proportion of patients capturing the applied topical drug by camera and filling in the pain and itch scores was defined as e-diary adherence, and patients' perception of usefulness and acceptability of the e-diary were evaluated. RESULTS Treatment adherence rates of the included 256 patients were high (median 98%, range 97-99%). E-diary adherence was also high with a median of 93% (range 87-97%) for capturing the applied drug by camera, and 89% (range 87-96%) and 94% (range 87-96%) for entering respectively the itch and pain score. Daily symptom scores provided good insights into the disease burden, and patients rated the e-diary as good to excellent with respect to user acceptability. CONCLUSIONS The results suggest that the e-diary is an excellent way to ensure proper treatment administration, indicated by both the high user acceptability scores and high treatment adherence. Moreover, the e-diary may also be valuable for frequent and reliable monitoring of patient-reported outcomes in daily clinical practice.
Collapse
Affiliation(s)
| | | | - R. Rijneveld
- Centre for Human Drug ResearchLeidenThe Netherlands
| | | | | | - J.N. Bouwes Bavinck
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - M.B.A. van Doorn
- Department of DermatologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - G. Feiss
- Cutanea Life ScienceWaynePennsylvaniaUSA
| | - A.F. Cohen
- Centre for Human Drug ResearchLeidenThe Netherlands
| | - J. Burggraaf
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | - M.I.E. van Poelgeest
- Centre for Human Drug ResearchLeidenThe Netherlands
- Department of Gynecology and ObstetricsLeiden University Medical CenterLeidenThe Netherlands
| | - R. Rissmann
- Centre for Human Drug ResearchLeidenThe Netherlands
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
| |
Collapse
|
8
|
Schaap DP, de Valk KS, Deken MM, Meijer RPJ, Burggraaf J, Vahrmeijer AL, Kusters M. Carcinoembryonic antigen-specific, fluorescent image-guided cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for metastatic colorectal cancer. Br J Surg 2020; 107:334-337. [PMID: 31960953 PMCID: PMC7079046 DOI: 10.1002/bjs.11523] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/27/2019] [Accepted: 01/09/2020] [Indexed: 12/29/2022]
Affiliation(s)
- D P Schaap
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - K S de Valk
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - M M Deken
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - R P J Meijer
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, Netherlands
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - M Kusters
- Department of Surgery, Amsterdam University Medical Centres, location VUmc, Amsterdam, Netherlands
| | | |
Collapse
|
9
|
Huisman BW, Burggraaf J, Vahrmeijer AL, Schoones JW, Rissmann RA, Sier CFM, van Poelgeest MIE. Potential targets for tumor-specific imaging of vulvar squamous cell carcinoma: A systematic review of candidate biomarkers. Gynecol Oncol 2020; 156:734-743. [PMID: 31928804 DOI: 10.1016/j.ygyno.2019.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Vulvar squamous cell carcinoma (VSCC) is a rare malignancy with an increasing incidence, especially in young women. Surgical treatment of VSCC is associated with significant morbidity and high recurrence rates, which is related to the limited ability to distinguish (pre)malignant from healthy tissue. There is a need for new tools for specific real-time detection of occult tumor lesions and localization of cancer margins in patients with VSCC. Several tumor-specific imaging techniques are developed to recognize malignant tissue by targeting tumor markers. We present a systematic review to identify, evaluate, and summarize potential markers for tumor-specific imaging of VSCC. METHODS Relevant papers were identified by a systematic cross-database literature search developed with assistance of an experienced librarian. Data were extracted from eligible papers and reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. VSCC-specific tumor markers were valued based on a weighted scoring system, in which each biomarker was granted points based on ranked eligibility criteria: I) percentage expression, II) sample size, and III) in vivo application. RESULTS In total 627 papers were included of which 22 articles met the eligibility criteria. Twelve VSCC-specific tumor markers were identified and of these 7 biomarkers were considered most promising: EGFR, CD44v6, GLUT1, MRP1, MUC1, CXCR-4 and VEGF-A. DISCUSSION This overview identified 7 potential biomarkers that can be used in the development of VSCC-specific tracers for real-time and precise localization of tumor tissue before, during, and after treatment. These biomarkers were identified in a small number of samples, without discriminating for VSCC-specific hallmarks such as HPV-status. Before clinical development, experimental studies should first aim at validation of these biomarkers using immunohistochemistry and cell line-based examination, discriminating for HPV-status and the expression rate in lymph nodes and precursor lesions.
Collapse
Affiliation(s)
- B W Huisman
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - J Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Einstein weg 55, 2333 CC Leiden, the Netherlands; Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, the Netherlands.
| | - R A Rissmann
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Leiden Academic Center for Drug Research, Leiden University, Einstein weg 55, 2333 CC Leiden, the Netherlands.
| | - C F M Sier
- Department of Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| | - M I E van Poelgeest
- Centre for Human Drug Research, Zernikedreef 8, 2333CL Leiden, the Netherlands; Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.
| |
Collapse
|
10
|
Rijsbergen M, Rijneveld R, Todd M, Pagan L, Feiss G, de Koning MNC, van Alewijk DCJG, Klaassen ES, Burggraaf J, Rissmann R, van Poelgeest MIE. No effect of topical digoxin and furosemide gel for patients with external anogenital warts. J Eur Acad Dermatol Venereol 2019; 34:e45-e46. [PMID: 31430405 DOI: 10.1111/jdv.15894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Rijsbergen
- Centre for Human Drug Research, Leiden, The Netherlands
| | - R Rijneveld
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M Todd
- Centre for Human Drug Research, Leiden, The Netherlands
| | - L Pagan
- Centre for Human Drug Research, Leiden, The Netherlands
| | - G Feiss
- Cutanea Life Sciences, Wayne, PA, USA
| | | | | | - E S Klaassen
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - R Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - M I E van Poelgeest
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
11
|
Dijkmans AC, Kweekel DM, Balmforth C, van Esdonk MJ, van Dissel JT, Burggraaf J, Kamerling IMC. The simplified oral flucloxacillin absorption test: an accurate method to identify patients with inadequate oral flucloxacillin absorption. Neth J Med 2019; 77:255-260. [PMID: 31582580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The preferred treatment for severe methicillin-sensitive Staphylococcus aureus infections is flucloxacillin, a small-spectrum antibiotic administered intravenously (IV) and orally. However, clinicians switch to the less preferred broad-spectrum antibiotics because of the variable absorption after oral administration of flucloxacillin. A classical oral absorption test (OAT) requires overnight fasting and interruption of IV therapy, and is laborious. In the current study, we investigated whether a simplified OAT can be utilized in a clinical setting to guide antibiotic treatment in patients with severe S. aureus infections. For this, OAT IV therapy is continued and oral dosing is performed after a one-hour fast and implemented after a small study. METHODS In 196 patients receiving IV flucloxacillin by continuous infusion, a classical OAT (test A) or simplified version of the OAT (test B) was performed. In both tests, 1 g oral flucloxacillin was given and serum samples were taken prior to intake and at one and two hours after administration. Flucloxacillin concentrations were determined by high-performance liquid chromatography. Adequate absorption was defined as an increase of flucloxacillin concentration of at least 10 mg/l after one or two hours compared to baseline. RESULTS In a sample of 196 patients (85 F/111 M), test A was performed in 28 patients, and test B in 168 patients. Age, gender, and baseline values of creatinine and albumin were similar in both groups. The maximal increase of flucloxacillin absorption was highly variable between patients. In 26 (13%) of the 196 patients, the flucloxacillin increase did not reach the value of 10 mg/l. The median (interquartile range, IQR) maximal increase of flucloxacillin absorption was 22.0 (15-31.25) mg/l for test A and 21.5 (13-32.25) mg/l for test B. There was no significant difference in maximal increase of flucloxacillin absorption between test A and B (p = 0.74), nor between males and females (p = 0.95). Age, creatinine, and albumin were not correlated with flucloxacillin levels. CONCLUSIONS The simplified version of the OAT is useful to identify patients with adequate oral flucloxacillin absorption, and to ensure the effective continuation of an oral small-spectrum treatment.
Collapse
Affiliation(s)
- A C Dijkmans
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
12
|
Hassing GJ, van der Wall HEC, van Westen GJP, Kemme MJB, Adiyaman A, Elvan A, Burggraaf J, Gal P. Body mass index related electrocardiographic findings in healthy young individuals with a normal body mass index. Neth Heart J 2019; 27:506-512. [PMID: 31111455 PMCID: PMC6773792 DOI: 10.1007/s12471-019-1282-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION An increased body mass index (BMI) (>25 kg/m2) is associated with a wide range of electrocardiographic changes. However, the association between electrocardiographic changes and BMI in healthy young individuals with a normal BMI (18.5-25 kg/m2) is unknown. The aim of this study was to evaluate the association between BMI and electrocardiographic parameters. METHODS Data from 1,290 volunteers aged 18 to 30 years collected at our centre were analysed. Only subjects considered healthy by a physician after review of collected data with a normal BMI and in sinus rhythm were included in the analysis. Subjects with a normal BMI (18.5-25 kg/m2) were divided into BMI quartiles analysis and a backward multivariate regression analysis with a normal BMI as a continuous variable was performed. RESULTS Mean age was 22.7 ± 3.0 years, mean BMI was 22.0, and 73.4% were male. There were significant differences between the BMI quartiles in terms of maximum P-wave duration, P-wave balance, total P-wave area in lead V1, PR-interval duration, and heart axis. In the multivariate model maximum P-wave duration (standardised coefficient (SC) = +0.112, P < 0.001), P-wave balance in lead V1 (SC = +0.072, P < 0.001), heart axis (SC = -0.164, P < 0.001), and Sokolow-Lyon voltage (SC = -0.097, P < 0.001) were independently associated with BMI. CONCLUSION Increased BMI was related with discrete electrocardiographic alterations including an increased P-wave duration, increased P-wave balance, a leftward shift of the heart axis, and decreased Sokolow-Lyon voltage on a standard twelve lead electrocardiogram in healthy young individuals with a normal BMI.
Collapse
Affiliation(s)
- G J Hassing
- Centre for Human Drug Research, Leiden, The Netherlands
| | - H E C van der Wall
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - G J P van Westen
- Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - M J B Kemme
- Department of Cardiology, VU Medical Center, Amsterdam, The Netherlands
| | - A Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - A Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands.,Leiden Academic Centre for Drug Research, Leiden, The Netherlands.,Leiden University Medical Center, Leiden, The Netherlands
| | - P Gal
- Centre for Human Drug Research, Leiden, The Netherlands.
| |
Collapse
|
13
|
Rijsbergen M, Niemeyer‐van der Kolk T, Hogendoorn G, Kouwenhoven S, Lemoine C, Klaassen E, de Koning M, Beck S, Bouwes Bavinck J, Feiss G, Burggraaf J, Rissmann R. Digoxin with furosemide is efficacious in cutaneous warts. Br J Dermatol 2019. [DOI: 10.1111/bjd.17803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Rijsbergen M, Niemeyer‐van der Kolk T, Hogendoorn G, Kouwenhoven S, Lemoine C, Klaassen E, Koning M, Beck S, Bouwes Bavinck J, Feiss G, Burggraaf J, Rissmann R. 地高辛联合呋塞米对于皮肤疣有效. Br J Dermatol 2019. [DOI: 10.1111/bjd.17815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Rijsbergen M, Pagan L, Niemeyer-van der Kolk T, Rijneveld R, Hogendoorn G, Lemoine C, Meija Miranda Y, Feiss G, Bouwes Bavink JN, Burggraaf J, van Poelgeest MIE, Rissmann R. Stereophotogrammetric three-dimensional photography is an accurate and precise planimetric method for the clinical visualization and quantification of human papilloma virus-induced skin lesions. J Eur Acad Dermatol Venereol 2019; 33:1506-1512. [PMID: 30720900 PMCID: PMC6767777 DOI: 10.1111/jdv.15474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/14/2019] [Indexed: 01/26/2023]
Abstract
Background The quantification of human papilloma virus (HPV)‐induced skin lesions is essential for the clinical assessment of the course of disease and the response to treatment. However, clinical assessments that measure dimensions of lesions using a caliper do not provide complete insight into three‐dimensional (3D) lesions, and its inter‐rater variability is often poor. Objective The aim of this study was to validate a stereophotogrammetric 3D camera system for the quantification of HPV‐induced lesions. Methods The camera system was validated for accuracy, precision and interoperator and inter‐rater variability. Subsequently, 3D photographs were quantified and compared to caliper measurements for clinical validation by Bland–Altman modelling, based on data from 80 patients with cutaneous warts (CW), 24 with anogenital warts (AGW) patients and 12 with high‐grade squamous intraepithelial lesions of the vulva (vulvar HSIL) with a total lesion count of 220 CW, 74 AGW and 31 vulvar HSIL. Results Technical validation showed excellent accuracy [coefficients of variation (CV) ≤ 0.68%] and reproducibility (CVs ≤ 2%), a good to excellent agreement between operators (CVs ≤ 8.7%) and a good to excellent agreement between different raters for all three lesion types (ICCs ≥ 0.86). When comparing 3D with caliper measurements, excellent biases were found for diameter of AGW (long diameter 5%), good biases were found for diameter of AGW (short diameter 10%) and height of CW (8%), and acceptable biases were found for the diameter of CW (11%) and vulvar HSIL (short diameter 14%, long diameter 16%). An unfavourable difference between these methods (bias 25%) was found for the assessment of height of AGWs. Conclusion Stereophotogrammetric 3D imaging is an accurate and reliable method for the clinical visualization and quantification of HPV‐induced skin lesions. Linked Commentary: M. Skerlev et al. J Eur Acad Dermatol Venereol 2019; 33: 1445–1446. https://doi.org/10.1111/jdv.15791.
Collapse
Affiliation(s)
- M Rijsbergen
- Centre for Human Drug Research, Leiden, the Netherlands
| | - L Pagan
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | - R Rijneveld
- Centre for Human Drug Research, Leiden, the Netherlands
| | - G Hogendoorn
- Centre for Human Drug Research, Leiden, the Netherlands
| | - C Lemoine
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | - G Feiss
- Cutanea Life Sciences, Wayne, PA, USA
| | - J N Bouwes Bavink
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden/Amsterdam Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - M I E van Poelgeest
- Centre for Human Drug Research, Leiden, the Netherlands.,Department of Gynecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - R Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands.,Leiden/Amsterdam Centre for Drug Research, Leiden University, Leiden, the Netherlands
| |
Collapse
|
16
|
Rijsbergen M, Niemeyer-van der Kolk T, Hogendoorn G, Kouwenhoven S, Lemoine C, Klaassen ES, de Koning M, Beck S, Bouwes Bavinck JN, Feiss G, Burggraaf J, Rissmann R. A randomized controlled proof-of-concept trial of digoxin and furosemide in adults with cutaneous warts. Br J Dermatol 2019; 180:1058-1068. [PMID: 30580460 PMCID: PMC6850412 DOI: 10.1111/bjd.17583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Background Topical ionic contraviral therapy (ICVT) with digoxin and furosemide inhibits the potassium influx on which DNA viruses rely for replication. Therefore, ICVT was hypothesized to be a potential novel treatment for cutaneous warts. Objectives To assess the clinical efficacy, safety and tolerability of ICVT in adults with cutaneous warts. The secondary objective was to gain insight into the underlying working mechanism of ICVT. Methods Treatment with ICVT was assessed for efficacy, safety and tolerability in a single‐ centre, randomized, double‐blind, placebo‐controlled phase IIA trial. Eighty adult patients with at least two cutaneous warts (plantar or common) were randomized to one of four treatments: digoxin + furosemide (0·125%), digoxin (0·125%), furosemide (0·125%) or placebo. The gel was administered once daily for 42 consecutive days. Predefined statistical analysis was performed with a mixed‐model ancova. The trial was registered at ClinicalTrials.gov with number NCT02333643. Results Wart size and human papillomavirus (HPV) load reduction was achieved in all active treatment groups. A statistically significant reduction in wart diameter of all treated warts was shown in the digoxin + furosemide treatment group vs. placebo (−3·0 mm, 95% confidence interval −4·9 to −1·1, P = 0·002). There was a statistically significant reduction in the HPV load of all treated warts in the digoxin + furosemide group vs. placebo (−94%, 95% confidence interval −100 to −19, P = 0·03). With wart size reduction, histologically and immunohistochemically defined viral characteristics disappeared from partial and total responding warts. Conclusions This study demonstrates the proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. What's already known about this topic? Cutaneous warts are caused by the human papillomavirus (HPV). Ionic contraviral therapy (ICVT) might be a potential treatment for cutaneous warts. A previous phase I/II open‐label study demonstrated the safety and efficacy of ICVT.
What does this study add? Proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. Topical ICVT demonstrates a favourable safety profile, with the effects most pronounced when it is combined in a formulation for common warts. Wart size reduction was related to HPV load reduction measured by quantitative polymerase chain reaction (qPCR) in swabs. qPCR is a valuable disease biomarker for drug development in cutaneous warts.
https://doi.org/10.1111/bjd.17803 available online https://www.bjdonline.com/article/
Collapse
Affiliation(s)
- M Rijsbergen
- Center for Human Drug Research, Leiden, the Netherlands
| | | | - G Hogendoorn
- Center for Human Drug Research, Leiden, the Netherlands
| | - S Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - C Lemoine
- Center for Human Drug Research, Leiden, the Netherlands
| | - E S Klaassen
- Center for Human Drug Research, Leiden, the Netherlands
| | - M de Koning
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - S Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, U.S.A
| | - J Burggraaf
- Center for Human Drug Research, Leiden, the Netherlands
| | - R Rissmann
- Center for Human Drug Research, Leiden, the Netherlands
| |
Collapse
|
17
|
Reijers JAA, Kallend DG, Malone KE, Jukema JW, Wijngaard PLJ, Burggraaf J, Moerland M. MDCO-216 Does Not Induce Adverse Immunostimulation, in Contrast to Its Predecessor ETC-216. Cardiovasc Drugs Ther 2018; 31:381-389. [PMID: 28844118 PMCID: PMC5591804 DOI: 10.1007/s10557-017-6746-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose Aim of this study was to demonstrate that MDCO-216 (human recombinant Apolipoprotein A-I Milano) does not induce adverse immunostimulation, in contrast to its predecessor, ETC-216, which was thought to contain host cell proteins (HCPs) that elicited an inflammatory reaction. Methods Data were taken from a clinical trial in which 24 healthy volunteers (HV) and 24 patients with proven stable coronary artery disease (sCAD) received a single intravenous dose of MDCO-216, ranging 5–40 mg/kg. Additionally, whole blood from 35 HV, 35 sCAD patients and 35 patients requiring acute coronary intervention (aCAD group) was stimulated ex vivo with MDCO-216 and ETC-216. Results No inflammatory reaction was observed in HV and sCAD patients following MDCO-216 treatment, judging by body temperature, white cell counts, neutrophil counts, C-reactive protein, circulating cytokines (IL-6, TNF-α), and adverse events. In the ex vivo experiment, the geometric means (SD) of the ratio of MDCO-216 stimulated IL-6 over background levels were 0.8 (1.9), 0.7 (1.5), 1.0 (2.0) for respectively HV, sCAD, aCAD. The corresponding ETC-216 stimulated values were 15.8 (2.9), 9.5 (3.6), 3.8 (4.0). TNF-α results were comparable. Because many ETC-216 stimulated samples had cytokine concentrations >ULOQ, ratios were categorised and marginal homogeneity of the contingency table (MDCO-216 versus ETC-216) was assessed with the Stuart-Maxwell test. P-values were ≤0.0005 for all populations. Conclusions MDCO-216 did not induce adverse immunostimulation in HV and sCAD patients, in contrast to ETC-216. Results from the ex vivo stimulation suggests the same holds true for aCAD patients.
Collapse
Affiliation(s)
- Joannes A A Reijers
- Centre for Human Drug Research, Zernikedreef 8, 2333CL, Leiden, The Netherlands. .,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - K E Malone
- Good Biomarker Sciences, Leiden, The Netherlands.,Janssen Prevention Center, Janssen Vaccines and Prevention B.V, Leiden, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - J Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333CL, Leiden, The Netherlands
| | - M Moerland
- Centre for Human Drug Research, Zernikedreef 8, 2333CL, Leiden, The Netherlands
| |
Collapse
|
18
|
Burggraaf J, Mylanus EAM, Pennings RJE, Cremers C. Malleostapedotomy with the self-fixing and articulated titanium piston. Eur Arch Otorhinolaryngol 2018; 275:1715-1722. [PMID: 29779038 PMCID: PMC5992232 DOI: 10.1007/s00405-018-4999-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/12/2018] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze the results of malleostapedotomy performed by applying the self-fixing and articulated titanium piston according to Häusler. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS AND INTERVENTIONS This study concerns a retrospective analysis of the results of malleostapedotomy with the use of a self-fixing articulated titanium piston in 16 ears of 16 consecutively treated patients between 2005 and 2009. The medical files were used for the acquisition of data on medical and surgical history and to obtain pre- and postoperative audiometry. Diagnosis and outcomes of mainly revision surgeries are presented and compared to the literature. MAIN OUTCOME MEASURES Effect of (revision) malleostapedotomy by evaluating postoperative audiometry and air-bone gap closure. RESULTS The postoperative air-bone gap closure was ≤ 10 dB in 9/16 (56%) ears and within ≤ 20 dB in 13/16 (81%) ears. The mean postoperative air-bone gap was 14.3 dB HL (0.5-2.0 kHz) and 17.3 dB HL (0.5-4.0 kHz). Postoperatively, there was no increase in bone conduction thresholds larger than 3 dB (0.5-2.0 kHz) and postoperative dizziness was absent or very limited and transient. CONCLUSIONS The malleostapedotomy procedure has become surgically less demanding over time by the technical improvements present in the nowadays available pistons. The design of the self-fixing and articulated titanium piston used in the present group of patients allows a safe and straight-forward malleostapedotomy procedure. Present hearing outcomes match with results presented in the literature.
Collapse
Affiliation(s)
- J Burggraaf
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E A M Mylanus
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - R J E Pennings
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Cor Cremers
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
19
|
Birkhoff W, de Vries J, Dent G, Verma A, Kerkhoffs J, van Meurs A, de Kam M, Moerland M, Burggraaf J. Retinal microcirculation imaging in sickle cell disease patients. Microvasc Res 2018; 116:1-5. [DOI: 10.1016/j.mvr.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/24/2023]
|
20
|
Hogendoorn G, Bruggink S, Hermans K, Kouwenhoven S, Quint K, Wolterbeek R, Eekhof J, de Koning M, Rissmann R, Burggraaf J, Bouwes Bavinck J. 开发和验证皮肤疣(CWARTS)诊断工具:一种新型皮肤疣临床评估和分类系统. Br J Dermatol 2018. [DOI: 10.1111/bjd.16299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
21
|
Hogendoorn G, Bruggink S, Hermans K, Kouwenhoven S, Quint K, Wolterbeek R, Eekhof J, de Koning M, Rissmann R, Burggraaf J, Bouwes Bavinck J. Developing and validating the Cutaneous WARTS (CWARTS) diagnostic tool: a novel clinical assessment and classification system for cutaneous warts. Br J Dermatol 2018. [DOI: 10.1111/bjd.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
22
|
Hogendoorn G, Bruggink S, de Koning M, Eekhof J, Hermans K, Rissmann R, Burggraaf J, Wolterbeek R, Quint K, Kouwenhoven S, Bouwes Bavinck J. 通过形态特征以及人乳头瘤病毒基因型预测治疗皮肤疣的疗效. Br J Dermatol 2018. [DOI: 10.1111/bjd.16187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Hogendoorn G, Bruggink S, de Koning M, Eekhof J, Hermans K, Rissmann R, Burggraaf J, Wolterbeek R, Quint K, Kouwenhoven S, Bouwes Bavinck J. Morphological characteristics and human papillomavirus genotype predict the treatment response in cutaneous warts. Br J Dermatol 2018. [DOI: 10.1111/bjd.16180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Hogendoorn GK, Bruggink SC, Hermans KE, Kouwenhoven STP, Quint KD, Wolterbeek R, Eekhof JAH, de Koning MNC, Rissmann R, Burggraaf J, Bouwes Bavinck JN. Developing and validating the Cutaneous WARTS (CWARTS) diagnostic tool: a novel clinical assessment and classification system for cutaneous warts. Br J Dermatol 2017; 178:527-534. [PMID: 28949011 DOI: 10.1111/bjd.15999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The clinical appearance of cutaneous warts is highly variable and not standardized. OBJECTIVES To develop and validate a reproducible clinical tool for the standardized assessment of cutaneous warts to distinguish these lesions accurately. METHODS Nine morphological characteristics were defined and validated regarding intra- and interobserver agreement. Based on literature and semistructured interviews, a systematic dichotomous assessment tool, the Cutaneous WARTS (CWARTS) diagnostic tool was developed. The validation consisted of two independent parts performed with photographs from the recent WARTS-2 trial. In part A, the CWARTS diagnostic tool was tested by 28 experienced physicians who assessed photographs of 10 different warts to investigate interobserver concordance. In part B, morphological characteristics were validated by masked and independent scoring of 299 photographs by six different observers. Part B also entailed reassessment of the photographs after at least 1 week. The primary outcome measurement was the intraclass correlation coefficient (ICC). RESULTS Presence of black dots (capillary thrombosis) had the greatest ICC (0·85) for interobserver agreement in part A, followed by arrangement (0·65), presence of border erythema (0·64) and sharpness of the border (0·60). In part B, results were similar for interobserver agreement with presence of black dots having the highest ICC (0·68), followed by border erythema (0·64), arrangement (0·58) and colour (0·55). For intraobserver agreement, presence of black dots had the highest agreement (0·70), followed by presence of border erythema (0·694) and colour (0·59). CONCLUSIONS Wart phenotype can be reliably assessed using the CWARTS diagnostic tool.
Collapse
Affiliation(s)
| | - S C Bruggink
- Departments of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - K E Hermans
- Departments of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - S T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - K D Quint
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - R Wolterbeek
- Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J A H Eekhof
- Departments of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - R Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
25
|
Hogendoorn G, Bruggink S, de Koning M, Eekhof J, Hermans K, Rissmann R, Burggraaf J, Wolterbeek R, Quint K, Kouwenhoven S, Bouwes Bavinck J. Morphological characteristics and human papillomavirus genotype predict the treatment response in cutaneous warts. Br J Dermatol 2017. [DOI: 10.1111/bjd.15758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G.K. Hogendoorn
- Centre for Human Drug Research Zernikedreef 8 2333 CL Leiden the Netherlands
| | - S.C. Bruggink
- Department of Public Health and Primary Care Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - M.N.C. de Koning
- DDL Diagnostic Laboratory Visseringlaan 25 2288 ER Rijswijk the Netherlands
| | - J.A.H. Eekhof
- Department of Public Health and Primary Care Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - K.E. Hermans
- Department of Public Health and Primary Care Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - R. Rissmann
- Centre for Human Drug Research Zernikedreef 8 2333 CL Leiden the Netherlands
| | - J. Burggraaf
- Centre for Human Drug Research Zernikedreef 8 2333 CL Leiden the Netherlands
| | - R. Wolterbeek
- Department of Medical Statistics Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - K.D. Quint
- Department of Dermatology Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
- Department of Dermatology Roosevelt Clinics Rooseveltstraat 67 2321 BL Leiden the Netherlands
| | - S.T.P. Kouwenhoven
- Department of Dermatology Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - J.N. Bouwes Bavinck
- Department of Dermatology Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| |
Collapse
|
26
|
Ducore J, Lawrence JB, Simpson M, Boggio L, Bellon A, Burggraaf J, Stevens J, Moerland M, Frieling J, Reijers J, Wang M. Safety and dose-dependency of eptacog beta (activated) in a dose escalation study of non-bleeding congenital haemophilia A or B patients, with or without inhibitors. Haemophilia 2017; 23:844-851. [PMID: 28984010 DOI: 10.1111/hae.13357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Varying initial doses of activated eptacog beta (recombinant human FVIIa, rhFVIIa) may provide therapeutic options when treating bleeding in patients with congenital haemophilia who have developed inhibitory antibodies to factor VIII (FVIII) or factor IX (FIX). This study evaluated escalated doses of a new rhFVIIa product as a prelude to selecting the doses for clinical efficacy evaluation in haemophilia patients. AIM To assess the safety, pharmacokinetics, and laboratory pharmacodynamics of 3 doses of rhFVIIa in non-bleeding patients with congenital haemophilia A or B with or without inhibitors. METHODS Adult male patients (18-75 years old) with congenital haemophilia A or B (with or without inhibitors) received infusions of rhFVIIa at doses of 25, 75 or 225 μg/kg body weight. Ten patients were treated at each dose level, and each patient received 2 different dose levels. Descriptive methods were used to analyse the data. RESULTS Administration of rhFVIIa at all doses was well tolerated. Pharmacokinetic analyses showed that peak FVIIa plasma levels (Cmax ) were approximately proportional to dose and correlated well with peak thrombin generation. Total AUC0-inf also was approximately dose proportional. Clot formation and duration correlated with FVIIa activity. Repeat doses did not produce an immunological response. CONCLUSION In the first dose-escalation study of rhFVIIa to support product registration, eptacog beta at doses of 25, 75, and 225 μg/kg was pharmacodynamically active and well tolerated in non-bleeding patients with congenital haemophilia A or B.
Collapse
Affiliation(s)
- J Ducore
- University of California, Davis Health System, Sacramento, CA, USA
| | | | - M Simpson
- Rush University Medical Center, Chicago, IL, USA
| | - L Boggio
- Rush University Medical Center, Chicago, IL, USA
| | | | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Stevens
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M Moerland
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - J Reijers
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M Wang
- Hemophilia & Thrombosis Center, University of Colorado, Aurora, CO, USA
| |
Collapse
|
27
|
van der Kolk T, Dillingh MR, Rijneveld R, Klaassen ES, de Koning MNC, Kouwenhoven STP, Genders RE, Bouwes Bavinck JN, Feiss G, Rissmann R, Burggraaf J. Topical ionic contra-viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts. J Eur Acad Dermatol Venereol 2017; 31:2088-2090. [PMID: 28833595 PMCID: PMC5763383 DOI: 10.1111/jdv.14527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
Background DNA viruses such as HPV rely on K+ influx for replication. Both digoxin and furosemide inhibit the K+ influx by interacting with cell membrane ion co‐transporters (Na+/K+‐ATPase and Na+‐K+‐2Cl− co‐transporter‐1, respectively). We therefore hypothesized that these two compounds in a topical formulation may be valuable in the treatment of HPV‐induced warts. This new approach is called Ionic Contra‐Viral Therapy (ICVT). Objective To evaluate systemic exposure, safety and tolerability of ICVT with a combination of furosemide and digoxin after repeated topical application in subjects with common warts. Furthermore, we aimed to evaluate pharmacodynamics effects of ICVT. Methods Twelve healthy subjects with at least four common warts on their hands were included in the study and treated with a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on their lower back to assess safety and systemic exposure. Two warts were treated with 10 mg each and two served as negative controls to obtain preliminary evidence of treatment effect. Results ICVT was well tolerated topically, and there was no evidence of systemic exposure of digoxin or furosemide. There were no clinical relevant safety findings and no serious adverse events (SAEs). A rapid and statistically significant reduction in diameter, height and volume of the warts was already observed at day 14. Conclusion ICVT was found to be safe for administration to humans and 7 days of active treatment showed a statistical significant wart reduction compared to untreated control lesions, clearly indicating pharmacological activity.
Collapse
Affiliation(s)
| | - M R Dillingh
- Centre for Human Drug Research, Leiden, The Netherlands
| | - R Rijneveld
- Centre for Human Drug Research, Leiden, The Netherlands
| | - E S Klaassen
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - S T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, USA
| | - R Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
| |
Collapse
|
28
|
Boogerd LSF, Vuijk FA, Hoogstins CES, Handgraaf HJM, van der Valk MJM, Kuppen PJK, Sier CFM, van de Velde CJH, Burggraaf J, Fariña-Sarasqueta A, Vahrmeijer AL. Correlation Between Preoperative Serum Carcinoembryonic Antigen Levels and Expression on Pancreatic and Rectal Cancer Tissue. Biomark Cancer 2017; 9:1179299X17710016. [PMID: 28579847 PMCID: PMC5437985 DOI: 10.1177/1179299x17710016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/25/2017] [Indexed: 12/21/2022]
Abstract
Carcinoembryonic antigen (CEA)-targeted imaging and therapeutic agents are being tested in clinical trials. If CEA overexpression in malignant tissue corresponds with elevated serum CEA, serum CEA could assist in selecting patients who may benefit from CEA-targeted agents. This study aims to assess the relationship between serum CEA and CEA expression in pancreatic (n = 20) and rectal cancer tissues (n = 35) using histopathology. According to local laboratory standards, a serum CEA >3 ng/mL was considered elevated. In pancreatic cancer patients a significant correlation between serum CEA and percentage of CEA-expressing tumor cells was observed (P = .04, ρ = .47). All 6 patients with homogeneous CEA expression in the tumor had a serum CEA >3 ng/mL. Most rectal cancer tissues (32/35) showed homogeneous CEA expression, independent of serum CEA levels. This study suggests that selection of pancreatic cancer patients for CEA-targeted agents via serum CEA appears adequate. For selection of rectal cancer patients, serum CEA levels are not informative.
Collapse
Affiliation(s)
- L S F Boogerd
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - F A Vuijk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C E S Hoogstins
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - H J M Handgraaf
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M J M van der Valk
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - P J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
| | - A Fariña-Sarasqueta
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
29
|
Kervezee L, Burggraaf J. Response to "Time of the Day and Magnitude of the Effect of a Drug on the QTc Interval". CPT Pharmacometrics Syst Pharmacol 2017; 6:284. [PMID: 28194906 PMCID: PMC5445228 DOI: 10.1002/psp4.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
- L Kervezee
- Laboratory for Neurophysiology, Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
| |
Collapse
|
30
|
Dijkmans AC, Kuiper SG, Burggraaf J, Mouton JW, Wilms EB, Touw DJ, Stevens J, van Nieuwkoop C, Kamerling IMC. [Fosfomycin, an old antibiotic with new possibilities]. Ned Tijdschr Geneeskd 2017; 161:D973. [PMID: 28612692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Fosfomycin is a broad-spectrum antibiotic agent used orally for uncomplicated cystitis. The intravenous form of administration has recently been authorised in the Netherlands.- Thanks to its broad spectrum and extensive tissue penetration, fosfomycin offers possibilities for the treatment of infections in different organs.- Infections with multidrug-resistant bacteria pose a significant threat to public health. Many of these multidrug-resistant bacteria are sensitive to fosfomycin, which means fosfomycin may be an option for the treatment of infections with multidrug-resistant bacteria. - There is a lack of knowledge about the pharmacological properties of fosfomycin to establish a good dosing schedule. Knowledge is also lacking about the safety of fosfomycin and the extent of its tolerability in the treatment of different infections. - More research is needed before fosfomycin can be used in the battle against multidrug-resistant bacteria.
Collapse
|
31
|
van Meir H, Nout RA, Welters MJP, Loof NM, de Kam ML, van Ham JJ, Samuels S, Kenter GG, Cohen AF, Melief CJM, Burggraaf J, van Poelgeest MIE, van der Burg SH. Impact of (chemo)radiotherapy on immune cell composition and function in cervical cancer patients. Oncoimmunology 2016; 6:e1267095. [PMID: 28344877 PMCID: PMC5353924 DOI: 10.1080/2162402x.2016.1267095] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 11/13/2022] Open
Abstract
New treatments based on combinations of standard therapeutic modalities and immunotherapy are of potential use, but require a profound understanding of immune modulatory properties of standard therapies. Here, the impact of standard (chemo)radiotherapy on the immune system of cervical cancer patients was evaluated. Thirty patients with cervical cancer were treated with external beam radiation therapy (EBRT), using conventional three-dimensional or intensity modulated radiation therapy without constraints for bone marrow sparing. Serial blood sampling for immunomonitoring was performed before, midway and at 3, 6 and 9 weeks after EBRT to analyze the composition of lymphocyte and myeloid-cell populations, the expression of co-stimulatory molecules, T-cell reactivity and antigen presenting cell (APC) function. Therapy significantly decreased the absolute numbers of circulating leukocytes and lymphocytes. Furthermore, the capacity of the remaining T cells to respond to antigenic or mitogenic stimulation was impaired. During treatment the frequency of both CD4+ and CD8+ T cells dropped and CD4+ T cells displayed an increased expression of programmed cell death-1 (PD-1). In vitro blocking of PD-1 successfully increased T-cell reactivity in all five samples isolated before radiotherapy but was less successful in restoring reactivity in samples isolated at later time points. Moreover, (chemo)radiotherapy was associated with an increase in both circulating monocytes and myeloid-derived suppressor cells (MDSCs) and an impaired capacity of APCs to stimulate allogeneic T cells. T-cell reactivity was slowly restored at 6–9 weeks after cessation of therapy. We conclude that conventional (chemo)radiotherapy profoundly suppresses the immune system in cervical cancer patients, and may restrict its combination with immunotherapy.
Collapse
Affiliation(s)
- H van Meir
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands; Centre for Human Drug Research, Leiden, the Netherlands
| | - R A Nout
- Department of Radiation Oncology, Leiden University Medical Center , Leiden, the Netherlands
| | - M J P Welters
- Department of Medical Oncology, Leiden University Medical Center , Leiden, the Netherlands
| | - N M Loof
- Department of Medical Oncology, Leiden University Medical Center , Leiden, the Netherlands
| | - M L de Kam
- Centre for Human Drug Research , Leiden, the Netherlands
| | - J J van Ham
- Department of Medical Oncology, Leiden University Medical Center , Leiden, the Netherlands
| | - S Samuels
- Center Gynecological Oncology Amsterdam , NKI-AvL , Amsterdam, the Netherlands
| | - G G Kenter
- Center Gynecological Oncology Amsterdam , NKI-AvL , Amsterdam, the Netherlands
| | - A F Cohen
- Centre for Human Drug Research , Leiden, the Netherlands
| | | | - J Burggraaf
- Centre for Human Drug Research , Leiden, the Netherlands
| | - M I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center , Leiden, the Netherlands
| | - S H van der Burg
- Department of Medical Oncology, Leiden University Medical Center , Leiden, the Netherlands
| |
Collapse
|
32
|
Monnet E, Lapeyre G, Poelgeest EV, Jacqmin P, Graaf KD, Reijers J, Moerland M, Burggraaf J, Min CD. Evidence of NI-0101 pharmacological activity, an anti-TLR4 antibody, in a randomized phase I dose escalation study in healthy volunteers receiving LPS. Clin Pharmacol Ther 2016; 101:200-208. [PMID: 27706798 DOI: 10.1002/cpt.522] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/31/2016] [Accepted: 09/21/2016] [Indexed: 12/19/2022]
Abstract
Toll-like receptor-4 (TLR4) pathways are major contributors to pathological inflammatory responses induced by tissue damage. NI-0101 is the first monoclonal antibody (mAb) blocking TLR4 signaling. This activity is independent of the ligand type and concentration, therefore, potentially blocking any TLR4 ligands. A phase I single ascending dose study was conducted in 73 healthy volunteers to evaluate NI-0101 tolerability, preliminary safety, pharmacokinetics (PKs), and pharmacodynamics (PDs), in absence and in presence of a systemic challenge with lipopolysaccharide (LPS), a TLR4 ligand. NI-0101 was well tolerated without safety concern. The PK profile was characterized by a half-life of ∼10 days at high concentrations and by a rapid elimination at low concentrations due to expected target-mediated drug disposition. NI-0101 prevented cytokine release following ex vivo and in vivo LPS administration and prevented the C-reactive protein (CRP) increase and the occurrence of flu-like symptoms expected following the in vivo administration of LPS.
Collapse
Affiliation(s)
- E Monnet
- Novimmune SA, Plan-les-Ouates, Switzerland.,MnS, Belgium
| | - G Lapeyre
- Novimmune SA, Plan-les-Ouates, Switzerland
| | - E van Poelgeest
- Center for Human Drug Research (CHDR), Leiden, The Netherlands
| | | | - K de Graaf
- Novimmune SA, Plan-les-Ouates, Switzerland
| | - J Reijers
- Center for Human Drug Research (CHDR), Leiden, The Netherlands
| | - M Moerland
- Center for Human Drug Research (CHDR), Leiden, The Netherlands
| | - J Burggraaf
- Center for Human Drug Research (CHDR), Leiden, The Netherlands
| | - C de Min
- Novimmune SA, Plan-les-Ouates, Switzerland
| |
Collapse
|
33
|
Kervezee L, Gotta V, Stevens J, Birkhoff W, Kamerling I, Danhof M, Meijer JH, Burggraaf J. Levofloxacin-Induced QTc Prolongation Depends on the Time of Drug Administration. CPT Pharmacometrics Syst Pharmacol 2016; 5:466-74. [PMID: 27479699 PMCID: PMC5036421 DOI: 10.1002/psp4.12085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/24/2016] [Indexed: 12/21/2022]
Abstract
Understanding the factors influencing a drug's potential to prolong the QTc interval on an electrocardiogram is essential for the correct evaluation of its safety profile. To explore the effect of dosing time on drug‐induced QTc prolongation, a randomized, crossover, clinical trial was conducted in which 12 healthy male subjects received levofloxacin at 02:00, 06:00, 10:00, 14:00, 18:00, and 22:00. Using a pharmacokinetic‐pharmacodynamic (PK‐PD) modeling approach to account for variations in PKs, heart rate, and daily variation in baseline QT, we find that the concentration‐QT relationship shows a 24‐hour sinusoidal rhythm. Simulations show that the extent of levofloxacin‐induced QT prolongation depends on dosing time, with the largest effect at 14:00 (1.73 (95% prediction interval: 1.56–1.90) ms per mg/L) and the smallest effect at 06:00 (−0.04 (−0.19 to 0.12) ms per mg/L). These results suggest that a 24‐hour variation in the concentration‐QT relationship could be a potentially confounding factor in the assessment of drug‐induced QTc prolongation.
Collapse
Affiliation(s)
- L Kervezee
- Laboratory for Neurophysiology, Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands.,Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - V Gotta
- Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - J Stevens
- Centre for Human Drug Research, Leiden, The Netherlands
| | - W Birkhoff
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Imc Kamerling
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M Danhof
- Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - J H Meijer
- Laboratory for Neurophysiology, Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands. .,Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.
| |
Collapse
|
34
|
Kallend DG, Reijers JAA, Bellibas SE, Bobillier A, Kempen H, Burggraaf J, Moerland M, Wijngaard PLJ. A single infusion of MDCO-216 (ApoA-1 Milano/POPC) increases ABCA1-mediated cholesterol efflux and pre-beta 1 HDL in healthy volunteers and patients with stable coronary artery disease. Eur Heart J Cardiovasc Pharmacother 2015; 2:23-9. [PMID: 27418968 PMCID: PMC4900740 DOI: 10.1093/ehjcvp/pvv041] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 12/26/2022]
Abstract
AIMS Apolipoprotein A-1 (ApoA-1), based on epidemiology, is inversely associated with cardiovascular (CV) events. Human carriers of the ApoA-1 Milano variant have a reduced incidence of CV disease. Regression of atherosclerotic plaque burden was previously observed on intravascular ultrasound (IVUS) with ETC-216, a predecessor of MDCO-216. MDCO-216, a complex of dimeric ApoA-1 Milano and 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphocholine, is being developed to reduce atherosclerotic plaque burden and CV events. We investigated the efficacy and safety of a single infusion of MDCO-216 in healthy volunteers and in patients with coronary artery disease (CAD). METHODS AND RESULTS Twenty-four healthy volunteers and 24 patients with documented CAD received a 2-h infusion of MDCO-216 in a randomized, placebo controlled, single ascending dose study. Five cohorts of healthy volunteers and four cohorts of CAD patients received ApoA-1 Milano doses ranging from 5 to 40 mg/kg. Subjects were followed for 30 days. Dose-dependent increases in ApoA-1, phospholipid, and pre-beta 1 HDL and decreases in ApoE were observed. Prominent and sustained increases in triglyceride, and decreases in HDL-C, endogenous ApoA-1 and ApoA-II occurred at doses >20 mg/kg and profound increases in ABCA1-mediated cholesterol efflux were observed. Other lipid and lipoprotein parameters were generally unchanged. MDCO-216 was well tolerated. CONCLUSIONS MDCO-216-modulated lipid parameters profoundly increased ABCA1-mediated cholesterol efflux and was well tolerated. These single-dose data support further development of this agent for reducing atherosclerotic disease and subsequent CV events.
Collapse
Affiliation(s)
- D G Kallend
- The Medicines Company (Schweiz) GmbH , Zürich , Switzerland
| | - J A A Reijers
- Centre for Human Drug Research , Leiden , The Netherlands
| | | | - A Bobillier
- The Medicines Company (Schweiz) GmbH , Zürich , Switzerland
| | - H Kempen
- The Medicines Company (Schweiz) GmbH , Zürich , Switzerland
| | - J Burggraaf
- Centre for Human Drug Research , Leiden , The Netherlands
| | - M Moerland
- Centre for Human Drug Research , Leiden , The Netherlands
| | | |
Collapse
|
35
|
Hoogstins C, Tummers Q, Cohen A, van de Velde C, Vahrmeijer A, Burggraaf J. A novel tumor-specific imaging agent for fluorescence guided surgery: a translational study. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
36
|
Hogendoorn G, Lemoine C, Rissmann R, Burggraaf J. 3D photography for Skin lesion Quantification. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
van Rongen A, Kervezee L, Brill MJE, van Meir H, den Hartigh J, Guchelaar HJ, Meijer JH, Burggraaf J, van Oosterhout F. Population Pharmacokinetic Model Characterizing 24-Hour Variation in the Pharmacokinetics of Oral and Intravenous Midazolam in Healthy Volunteers. CPT Pharmacometrics Syst Pharmacol 2015; 4:454-64. [PMID: 26380154 PMCID: PMC4562161 DOI: 10.1002/psp4.12007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/11/2015] [Indexed: 12/19/2022] Open
Abstract
Daily rhythms in physiology may affect the pharmacokinetics of a drug. The aim of this study was to evaluate 24-hour variation in the pharmacokinetics of the CYP3A substrate midazolam. Oral (2 mg) and intravenous (1 mg) midazolam was administered at six timepoints throughout the 24-hour period in 12 healthy volunteers. Oral bioavailability (population mean value [RSE%] of 0.28 (7.1%)) showed 24-hour variation that was best parameterized as a cosine function with an amplitude of 0.04 (17.3%) and a peak at 12:14 in the afternoon. The absorption rate constant was 1.41 (4.7%) times increased after drug administration at 14:00. Clearance (0.38 L/min (4.8%)) showed a minor 24-hour variation with an amplitude of 0.03 (14.8%) L/min and a peak at 18:50. Simulations show that dosing time minimally affects the concentration time profiles after intravenous administration, while concentrations are higher during the day compared to the night after oral dosing, reflecting considerable variation in intestinal processes.
Collapse
Affiliation(s)
- A van Rongen
- Department of Clinical Pharmacy, St. Antonius HospitalNieuwegein, The Netherlands
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden UniversityLeiden, The Netherlands
| | - L Kervezee
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden UniversityLeiden, The Netherlands
- Department of Molecular Cell Biology, Leiden University Medical CenterLeiden, The Netherlands
- Centre for Human Drug ResearchLeiden, The Netherlands
| | - MJE Brill
- Department of Clinical Pharmacy, St. Antonius HospitalNieuwegein, The Netherlands
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden UniversityLeiden, The Netherlands
| | - H van Meir
- Centre for Human Drug ResearchLeiden, The Netherlands
| | - J den Hartigh
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical CenterLeiden, The Netherlands
| | - H-J Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical CenterLeiden, The Netherlands
| | - JH Meijer
- Department of Molecular Cell Biology, Leiden University Medical CenterLeiden, The Netherlands
| | - J Burggraaf
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden UniversityLeiden, The Netherlands
- Centre for Human Drug ResearchLeiden, The Netherlands
| | - F van Oosterhout
- Department of Molecular Cell Biology, Leiden University Medical CenterLeiden, The Netherlands
- Centre for Human Drug ResearchLeiden, The Netherlands
| |
Collapse
|
38
|
Birkhoff W, de Vries J, Ruijs T, de Kam M, Moerland M, Burggraaf J. Noninvasive retinal and cutaneous Microcirculation imaging in sickle cell disease patients and Healthy Volunteers. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Kruithof A, Kamerling I, Mallikarjuna Rao D, Kumar R, Burggraaf J. Effect of food on the Pharmacokinetics of two formulations of a New cetp inhibitor in healthy Volunteers. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
40
|
Vlaming MLH, van Duijn E, Dillingh MR, Brands R, Windhorst AD, Hendrikse NH, Bosgra S, Burggraaf J, de Koning MC, Fidder A, Mocking JAJ, Sandman H, de Ligt RAF, Fabriek BO, Pasman WJ, Seinen W, Alves T, Carrondo M, Peixoto C, Peeters PAM, Vaes WHJ. Microdosing of a Carbon-14 Labeled Protein in Healthy Volunteers Accurately Predicts Its Pharmacokinetics at Therapeutic Dosages. Clin Pharmacol Ther 2015; 98:196-204. [PMID: 25869840 DOI: 10.1002/cpt.131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/30/2015] [Accepted: 04/06/2015] [Indexed: 11/12/2022]
Abstract
Preclinical development of new biological entities (NBEs), such as human protein therapeutics, requires considerable expenditure of time and costs. Poor prediction of pharmacokinetics in humans further reduces net efficiency. In this study, we show for the first time that pharmacokinetic data of NBEs in humans can be successfully obtained early in the drug development process by the use of microdosing in a small group of healthy subjects combined with ultrasensitive accelerator mass spectrometry (AMS). After only minimal preclinical testing, we performed a first-in-human phase 0/phase 1 trial with a human recombinant therapeutic protein (RESCuing Alkaline Phosphatase, human recombinant placental alkaline phosphatase [hRESCAP]) to assess its safety and kinetics. Pharmacokinetic analysis showed dose linearity from microdose (53 μg) [(14) C]-hRESCAP to therapeutic doses (up to 5.3 mg) of the protein in healthy volunteers. This study demonstrates the value of a microdosing approach in a very small cohort for accelerating the clinical development of NBEs.
Collapse
Affiliation(s)
| | | | - M R Dillingh
- Centre for Human Drug Research, Leiden, The Netherlands, UK
| | - R Brands
- AMRIF BV, Wageningen, The Netherlands, UK
| | - A D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands, UK
| | - N H Hendrikse
- Department of Pharmacy and Clinical Pharmacology, VU University Medical Center, Amsterdam, The Netherlands, UK
| | | | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands, UK
| | | | | | | | | | | | | | | | - W Seinen
- AMRIF BV, Wageningen, The Netherlands, UK.,Utrecht University, Utrecht, The Netherlands, UK
| | - T Alves
- GenIBET/IBET, Oeiras, Portugal
| | | | | | - P A M Peeters
- Centre for Human Drug Research, Leiden, The Netherlands, UK
| | | |
Collapse
|
41
|
Willemse PM, Hamdy NAT, de Kam ML, Burggraaf J, Osanto S. Changes in bone mineral density in newly diagnosed testicular cancer patients after anticancer treatment. J Clin Endocrinol Metab 2014; 99:4101-8. [PMID: 25119312 DOI: 10.1210/jc.2014-1722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with germ cell tumors (GCTs) have an excellent prognosis but are at risk for silent fractures. Data on bone mineral density (BMD) after anticancer treatment are scarce. OBJECTIVE The objective of the study was BMD monitoring in GCT patients treated with or without chemotherapy. DESIGN We prospectively studied 63 newly diagnosed GCT patients with a median age of 33 years (range 16-70 y) within 3 months of unilateral orchidectomy. Twenty-seven patients (42.9%) had no metastases. Thirty-six patients (57.1%) with metastatic disease received combination chemotherapy. SETTING This study was conducted at the outpatient clinic of a single academic institution. INTERVENTIONS We performed dual-energy X-ray absorptiometry scans and collected blood samples on a yearly basis, before and up to 5 years after anticancer treatment. MAIN OUTCOME MEASURES Changes in total hip and lumbar spine BMD, serum concentrations of gonadal hormones, and bone turnover markers were measured. RESULTS BMD remained normal in stage I patients. In patients with metastatic disease, a significant decrease in lumbar spine BMD (-1.52%; P = .004) and total hip BMD (-2.05%; P < .0001) was observed 1 year after chemotherapy and remained stable thereafter for up to 5 years. There was no significant relationship between the observed decrease in BMD and gonadal status, vitamin D status, or cumulative dose of cisplatin or (antiemetic) corticosteroids. CONCLUSIONS Metastatic GCT survivors demonstrate significant bone loss within the first year after curative combination chemotherapy, with no recovery up to 5 years after anticancer treatment. Whether this bone loss is associated with increased fracture risk and whether this could be prevented by bone modifying treatment remains to be established.
Collapse
Affiliation(s)
- P M Willemse
- Departments of Clinical Oncology (P.M.W., S.O.) and Endocrinology and Metabolic Diseases (N.A.T.H.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands, and Centre for Human Drug Research (M.L.d.K., J.B.), 2333 CL Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
42
|
Abstract
The development of a new medicine is a risky and costly undertaking that requires careful planning. This planning is largely applied to the operational aspects of the development and less so to the scientific objectives and methodology. The drugs that will be developed in the future will increasingly affect pathophysiological pathways that have been largely unexplored. Such drug prototypes cannot be immediately introduced in large clinical trials. The effects of the drug on normal physiology, pathophysiology, and eventually the desired clinical effects will need to be evaluated in a structured approach, based on the definition of drug development as providing answers to important questions by appropriate clinical studies. This review describes the selection process for biomarkers that are fit-for-purpose for the stage of drug development in which they are used. This structured and practical approach is widely applicable and particularly useful for the early stages of innovative drug development.
Collapse
Affiliation(s)
- A F Cohen
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands;
| | | | | | | | | |
Collapse
|
43
|
van Dongen MGJ, Geerts BF, Bhanot S, Morgan ES, de Kam ML, Moerland M, Romijn JA, Cohen AF, Burggraaf J. Characterization of a standardized glucagon challenge test as a pharmacodynamic tool in pharmacological research. Horm Metab Res 2014; 46:269-73. [PMID: 24402684 DOI: 10.1055/s-0033-1363223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to characterize a glucagon challenge test as a tool in diabetes research by assessing the inter- and intra-individual variability, and investigating the activity of the autonomic nervous system (ANS) during the challenge, as this might have an indirect impact on glucose homeostasis. The study was performed in 24 healthy volunteers separated in 2 groups. The first group of 12 volunteers underwent a 5-h glucagon challenge during a pancreatic clamp procedure with infusion of [6,6-2H2]-glucose infusion in combination with heart rate variability measurements. In the second group, 12 other healthy volunteers underwent two 6-h glucagon challenges separated by 6 weeks, and fat biopsies were taken for analysis of glucagon receptor expression. Serum glucose rose rapidly after glucagon infusion, and reached a plateau at 90 min. The time profiles suggested rapid development of tolerance for glucagon-induced hyperglycemia. During the glucagon challenge intra- and inter-individual variabilities for hepatic glucose production, the rate of disappearance of glucose, and plasma glucose were approximately 10-15% for all variables. Hyperglucagonemia did not affect heart rate variability. Human adipose tissue had a low, but variable, expression of glucagon receptor mRNA. This standardized glucagon challenge test has a good reproducibility with only limited variability over 6 weeks. It is a robust tool to explore in detail the contribution of glucagon in normal and altered glucose homeostasis and can also be used to evaluate the effects of drugs antagonizing glucagon action in humans without confounding changes in ANS tone.
Collapse
Affiliation(s)
| | - B F Geerts
- Leiden University Medical Center, Leiden, The Netherlands
| | - S Bhanot
- Isis Pharmaceuticals Inc, Carlsbad, CA, USA
| | - E S Morgan
- Isis Pharmaceuticals Inc, Carlsbad, CA, USA
| | - M L de Kam
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M Moerland
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J A Romijn
- Academic Medical Center, Amsterdam, The Netherlands
| | - A F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
| |
Collapse
|
44
|
Klein RH, Alvarez-Jimenez R, Sukhai RN, Oostdijk W, Bakker B, Reeser HM, Ballieux BEPB, Hu P, Klaassen ES, Freijer J, Burggraaf J, Cohen AF, Wit JM. Pharmacokinetics and pharmacodynamics of orally administered clonidine: a model-based approach. Horm Res Paediatr 2014; 79:300-9. [PMID: 23735833 DOI: 10.1159/000350819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 03/13/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The oral clonidine test is a diagnostic procedure performed in children with suspected growth hormone (GH) deficiency. It is associated with untoward effects, including bradycardia, hypotension and sedation. Serum clonidine levels have not previously been assessed during this test. METHODS In 40 children referred for an oral clonidine test, blood samples were drawn for clonidine and GH. Vital statistics and sedation scores were recorded until 210 min post-dose. We explored the relationship between clonidine concentrations and effects such as GH peak and blood pressure. RESULTS Of 40 participants, 5 children were GH deficient. Peak clonidine concentrations of 0.846 ± 0.288 ng/ml were reached after 1 h. Serum levels declined slowly, with concentrations of 0.701 ± 0.189 ng/ml 210 min post-dose. A large interindividual variation of serum levels was observed. During the procedure, systolic blood pressure dropped by 12.8%, diastolic blood pressure by 19.7% and heart rate by 8.4%. Moderate sedation levels were observed. Concentration-effect modeling showed that the amount of GH available for secretion as determined by previous bursts was an important factor influencing GH response. CONCLUSION Clonidine concentrations during the test were higher than necessary according to model-based predictions. A lower clonidine dose may be sufficient and may produce fewer side effects.
Collapse
Affiliation(s)
- R H Klein
- Centre for Human Drug Research, Leiden University Medical Center, NL-2300 RC Leiden, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
van Schinkel LD, Willemse PM, van der Meer RW, Burggraaf J, van Elderen SGC, Smit JWA, de Roos A, Osanto S, Lamb HJ. Reply: Comment on ‘Chemotherapy for testicular cancer induces acute alterations in diastolic heart function’. Br J Cancer 2014; 110:265. [PMID: 24201753 PMCID: PMC3887301 DOI: 10.1038/bjc.2013.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
46
|
Wijngaarden MA, Pijl H, van Dijk KW, Klaassen ES, Burggraaf J. Obesity is associated with an altered autonomic nervous system response to nutrient restriction. Clin Endocrinol (Oxf) 2013; 79:648-51. [PMID: 23252937 DOI: 10.1111/cen.12100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/02/2012] [Accepted: 11/07/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Heart rate variability (HRV) reflects the balance of activities of sympathetic and parasympathetic components of the autonomic nervous system. We compared HRV parameters in response to a prolonged fast in obese versus normal weight humans. In addition, the effect of weight-loss was evaluated in obese individuals. DESIGN Intervention study. PATIENTS The study subjects included 14 nondiabetic obese (12 females/2 males, aged 30 ± 3 years, Body Mass Index (BMI) 35·2 ± 1·2 kg/m(2) ) and 12 lean subjects (10 females/2 males, aged 27 ± 3 years, BMI 23·3 ± 0·5 kg/m(2) ). MEASUREMENTS HRV was examined 75 min after standardized breakfast and after a 48-h fast in 14 nondiabetic obese and 12 lean subjects. The postprandial measurement was repeated in 12 obese subjects after weight-loss. RESULTS In lean subjects, fasting decreased high-frequency (HF) power by 43% (P < 0·05) and decreased low-frequency (LF) power by 37% (P = 0·1), leaving the LF/HF ratio unchanged (P = 0·7). In the obese group, autonomic nervous system tone shifted to sympathetic dominance as the LF/HF increased from 0·61 to 1·14 (P = 0·03). After an average weight-loss of 13·8 kg in obese subjects, a trend for sympathetic dominance was found; the LF/HF ratio increased by 56% (P = 0·06). CONCLUSION Our data show that a 48-h fast leaves autonomic nervous system balance unaltered in lean subjects. In contrast, a 48-h fast, as well as weight-loss, induces sympathetic dominance in obese humans.
Collapse
Affiliation(s)
- M A Wijngaarden
- Department of Endocrinology & Metabolism, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
47
|
Willemse PM, Burggraaf J, Hamdy NAT, Osanto S. Reply: 'Comment on Prevalence of the metabolic syndrome and cardiovascular disease risk in chemotherapy-treated testicular germ cell tumour survivors'. Br J Cancer 2013; 109:2503-4. [PMID: 24045664 PMCID: PMC3817323 DOI: 10.1038/bjc.2013.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- P M Willemse
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 Leiden, ZA, The Netherlands
| | | | | | | |
Collapse
|
48
|
van Schinkel LD, Willemse PM, van der Meer RW, Burggraaf J, van Elderen SGC, Smit JWA, de Roos A, Osanto S, Lamb HJ. Chemotherapy for testicular cancer induces acute alterations in diastolic heart function. Br J Cancer 2013; 109:891-6. [PMID: 23922115 PMCID: PMC3749589 DOI: 10.1038/bjc.2013.445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/04/2013] [Accepted: 07/10/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND After treatment with cisplatin-based chemotherapy for testicular cancer (TC), patients have higher prevalence of cardiovascular complications after long-term follow up. Little is known about acute cardiovascular effects of cisplatin-based chemotherapy. The aim of this study was to explore acute effects of chemotherapy on cardiac function in patients treated for TC. METHODS Fourteen TC patients (age 34.6 ± 12.3 years) were studied before and 3 months after start with cisplatin-based chemotherapy. Cardiac function was assessed with magnetic resonance imaging. Fasting glucose and insulin levels were measured and insulin sensitivity, reflected by the quantitative insulin sensitivity index (Quicki index), was calculated. RESULTS Left ventricular (LV) end-diastolic volume and LV stroke volume (SV) significantly decreased from 192 ± 27 to 175 ± 26 ml (P<0.05) and 109 ± 18 to 95 ± 16 ml (P<0.05), respectively. The ratio of early and atrial filling velocities across the mitral valve, a parameter of diastolic heart function, decreased after chemotherapy from 1.87 ± 0.43 to 1.64 ± 0.45 (P<0.01). Metabolic parameters were unfavourably changed, reflected by a decreased Quicki index, which reduced from 0.39 ± 0.05 to 0.36 ± 0.05 (P<0.05). CONCLUSION Chemotherapy for TC induces acute alterations in diastolic heart function, paralleled by unfavourable metabolic changes. Therefore, early after chemotherapy, metabolic treatment may be indicated to possibly reduce long-term cardiovascular complications.
Collapse
Affiliation(s)
- L D van Schinkel
- Department of Endocrinology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Willemse PM, Burggraaf J, Hamdy NAT, Weijl NI, Vossen CY, van Wulften L, van Steijn-van Tol AQMJ, Rosendaal FR, Osanto S. Erratum: Prevalence of the metabolic syndrome and cardiovascular disease risk in chemotherapy-treated testicular germ cell tumour survivors. Br J Cancer 2013. [PMCID: PMC3708557 DOI: 10.1038/bjc.2013.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
50
|
Bosch J, de Nooij J, de Visser M, Cannegieter SC, Terpstra NJ, Heringhaus C, Burggraaf J. Prehospital use in emergency patients of a laryngeal mask airway by ambulance paramedics is a safe and effective alternative for endotracheal intubation. Emerg Med J 2013; 31:750-3. [PMID: 23771898 PMCID: PMC4145430 DOI: 10.1136/emermed-2012-202283] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In Dutch ambulance practice, failure or inability to intubate patients with altered oxygenation and/or ventilation leaves bag-valve mask ventilation as the only alternative, which is undesirable for patient outcome. A novel Laryngeal Mask Airway Supreme (LMA-S) device may be a suitable alternative. AIM To evaluate the effectiveness and suitability of the LMA-S for emergency medical services in daily out-of-hospital emergency practice. METHODS After a period of theoretical and practical training of ambulance paramedics in the use of the LMA-S, prospective data were collected on the utilisation of LMA-S in an observational study. Procedures for use were standardised and the evaluation included the number of direct intubation attempts before using LMA-S, attempts required, failure rate and the adequacy of ventilation. Data were analysed taking patient characteristics such as age and indication for ventilatory support into account. RESULTS The LMA-S was used 50 times over a period of 9 months (33 involving cardiorespiratory arrest, 14 primary and three rescue). The LMA-S could be applied successfully in all 50 cases (100%) and was successful in the first attempt in 49 patients (98%). Respiratory parameters showed adequate oxygenation. All paramedics were unanimously positive about the utilisation of LMA-S because of the easiness of the effort of insertion and general use, and emphasised its value as a useful resource for patients in need. CONCLUSIONS Ensuring ventilation support by using LMA-S by paramedics in prehospital emergency practice is safe and effective.
Collapse
Affiliation(s)
- J Bosch
- Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
| | - J de Nooij
- Medical Management, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
| | - M de Visser
- Research and Development, Regional Ambulance Service Hollands-Midden, Leiden, The Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N J Terpstra
- Department of Epidemiology, Regional Public Health Organisation Hollands Midden, Leiden, The Netherlands
| | - C Heringhaus
- Emergency Department, Leiden University Medical Center, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
| |
Collapse
|