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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Greenlund LK, Berkseth M, Shanley R, Sando N, Golden L, Wieworka J, Bergerud KB, Olin M, Pluhar GE, Arnold S, Lawrence J, Venteicher A, Chen C, Ferreira C, Neil E, Dusenbery KE, Ganguly S, Kleinberg LR, Terezakis SA, Sloan L. The Effects of Adjuvant Chemoradiotherapy (CRT) on Myeloid-Derived Suppressor Cell (MDSC) Subsets in Glioblastoma (GBM). Int J Radiat Oncol Biol Phys 2023; 117:e232. [PMID: 37784930 DOI: 10.1016/j.ijrobp.2023.06.1148] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) GBM continues to be a diagnosis with an exceedingly low survival rate despite standard therapy of resection followed by concurrent CRT. MDSC, immunosuppressive myeloid cells that aid immune system evasion by the tumor, expand during fractionated RT. To date, little is known about the effects of CRT on MDSC subsets. The goal of our pilot study is to compare peripheral blood MDSC subset frequency in patients (pts) undergoing CRT. We hypothesize that the pro-tumor, monocytic MDSC (M-MDSC) subset increases following CRT. MATERIALS/METHODS Pts over the age of 18 yo with a new diagnosis of GBM from a single institution participated in the study between 7/2022 -1/2023. Exclusion criteria included prior history of brain RT. Baseline peripheral blood samples were collected within one week prior to CRT start and post-CRT samples were collected within the last week of CRT. Peripheral blood mononuclear cells (PBMC) were isolated from whole blood and freshly stained for intracellular flow cytometric analyses. Total MDSC (singlet, viable, non-lymphocyte, CD11b+CD33+ HLA-DR- cells) and subsets (M-MDSC, granulocytic (G-MDSC), and early MDSC (eMDSC)) were identified. Percent frequency (%fx) of total and MDSC subsets as well as MDSC activation status (n = 3) (interleukin (IL)-10, transforming growth factor-β (TGF-β), interferon gamma (IFNγ)) was compared before and after CRT. RESULTS The average age of pts receiving CRT (n = 4) was 70 yo. Fractionated RT consisted of CF RT (n = 2), 6000 cGy in 30 fractions, and HF RT (n = 2), 4005 cGy in 15 fractions. All pts received concurrent chemotherapy with temozolomide. The %fx of MDSC of non-lymphocytes started at 29.2% prior to CRT and decreased to 9.9% at the end of CRT. The fold change of %fx of total MDSC in CF RT and HF RT was 0.39 and 0.29, respectively. The mean change in %fx of MDSC subsets before and after CRT are shown in Table 1. The mean %fx of TGF-β-expressing MDSC in all GBM pts increased by 3.5% after CRT. The mean IFNγ+ MDSC %fx for all GBM pts decreased after CRT from 24.2% to 16.2% with a corresponding decrease in geometric mean fluorescence intensity (GMFI). The mean %fx of IL-10+ MDSC decreased by 1.5% at the end of CRT with a decrease in GMFI from 5550 to 1806. CONCLUSION In this limited dataset of pts with GBM receiving standard of care adjuvant therapy, we identified an expansion in the eMDSC and decrease in the M-MDSC subsets. These early results suggest HF RT may promote immunity that is more supportive of anti-tumor function, with a lesser increase in fold change of total MDSC after CRT. A more detailed understanding of the effect of RT on myeloid subpopulations is essential to addressing immune suppression in pts with GBM.
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Affiliation(s)
- L K Greenlund
- University of Minnesota Medical School, Minneapolis, MN
| | - M Berkseth
- University of Minnesota, Minneapolis, MN
| | - R Shanley
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - N Sando
- University of Minnesota, Minneapolis, MN
| | - L Golden
- University of Minnesota, Minneapolis, MN
| | - J Wieworka
- University of Minnesota, Minneapolis, MN
| | | | - M Olin
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - G E Pluhar
- Department of Veterinary and Clinical Sciences, University of Minnesota, Minneapolis, MN
| | - S Arnold
- Department of Neurology, University of Minnesota Veterinary Medical Center, Minneapolis, MN
| | | | - A Venteicher
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN
| | - C Chen
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN
| | - C Ferreira
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - E Neil
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN
| | - K E Dusenbery
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - S Ganguly
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - L Sloan
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
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Easwaran TP, Demorest C, Alcorn SR, Sloan L, McClelland S, Terezakis SA. Impact of the Affordable Care Act on Pediatric Proton Radiation Therapy Access. Int J Radiat Oncol Biol Phys 2023; 117:e16. [PMID: 37784755 DOI: 10.1016/j.ijrobp.2023.06.682] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Previous work has demonstrated that socioeconomic factors affect the use of PT in children1. Medicaid expansion came into effect in 2014. In 2014, there were 15 proton centers in the US, which increased to 31 by 20202. The effects of increased PT center number and expansion of insurance coverage on PT access has yet to be investigated. MATERIALS/METHODS This was an observational cohort study using the National Cancer Database (NCDB) to assess for changes in utilization of PT for pediatric cancers before and after Medicaid expansion. Demographics and characteristics were summarized with one-way analysis of variance for continuous variables and χ2 for categorical variables. Data regarding geography of treated patients was suppressed. Logistic regression was performed to investigate the effect of SES and insurance on treatment type. All p values are two-sided, with a significance level of 0.05 used. Statistical analyses were performed in R (version 4.1.2). RESULTS There were 17,096 patients diagnosed at ages ≤21 years from 2004-2020 treated with either photon or PT with known insurance status. 14,491 patients were treated with photons; 2,605 patients received PT. The number of uninsured patients dropped after 2014 from 3.5% to 2.0%, p<0.001. The number of patients with Medicaid who received PT increased after 2014 (21.9% to 28.5%, p<0.001). From 2004-2020, PT increased from 0.4% to 12.4%, peaking in 2018 at 13.9%. Patients with private insurance had higher odds (OR1.5, CI 1.28-1.65) of PT compared to those with Medicaid when controlling for the increased likelihood of PT over time. Patients of higher SES had a higher likelihood of getting treated with PT both before and after Medicaid expansion, while those of the lowest quartile SES did not witness a significant change in the proportion of patients being treated with PT, (11.5% to 12.1% after 2014). Utilization based on race did not significantly change after 2014 among White, Black, and Asian/Pacific Islander populations, but did decrease for patients who identified as Spanish/Hispanic origin (16.9% to 15.0%, p<0.001), and American Indians from 0.7 to 1.3% (p<0.001). CONCLUSION Despite the benefits of Medicaid expansion from the ACA since 2014, pediatric patients of Black race and Hispanic ethnicity failed to experience improved access to PT. Pediatric patients with private insurance continued to be more likely to receive PT than patients on Medicaid. Investigation by geography, as well as tumor type, is necessary to provide essential data for creating effective policies to increase equitable access to PT.
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Affiliation(s)
- T P Easwaran
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - C Demorest
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - S R Alcorn
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - L Sloan
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - S McClelland
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | - S A Terezakis
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
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Wanhainen K, Berkseth M, Sando N, Golden L, Techam A, Wieworka J, Bergerud KB, Argenta P, O'Shea A, Rivard C, Ghebre R, Teoh D, Reynolds MA, Terezakis SA, Yuan J, Sloan L. Effect of External Beam Radiation Therapy (EBRT) and Brachytherapy (BT) on Circulating MDSC Populations in Patients Treated Definitively for Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e554. [PMID: 37785703 DOI: 10.1016/j.ijrobp.2023.06.1864] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The immunosuppressive function of myeloid derived suppressor cells (MDSCs) has been implicated in the regulation of immune responses against cancer. MDSCs have been associated with progression and poor response to therapy in various types of cancer, including cervical cancer. Radiation treatment (RT) alters immune cell populations within the tumor and is thought to augment antitumor responses. However, whether RT also recruits immunosuppressive MDSC populations is not well understood. Here, we investigate how circulating MDSC populations change in response to RT and if changes in MDSC frequency or subsets is predictive of RT responses in cervical cancer patients. MATERIALS/METHODS Newly diagnosed, treatment-naïve pts with locally advanced carcinoma of the cervix will be enrolled from July 2022 to July 2023. EBRT to the pelvis was delivered at a dose of 45 Gy in 25 fractions with a simultaneous integrated boost of 52-55 Gy to involved regional lymph nodes and parametria and concurrent weekly cisplatin. Gross tumor was boosted via interstitial or tandem ring BT (22.5-27.5 Gy) after completion of EBRT. Serial blood samples were collected prior to initiating therapy (T0), post-EBRT and pre-BT (T1), and one-month post-BT (T2). Treatment response was determined based on pre-treatment MRI compared to MRI post-EBRT. Peripheral blood mononuclear cells (PBMCs) were isolated from whole blood using density gradient centrifugation and stained for analysis via flow cytometry. MDSC populations were identified by Live/Dead-CD11b+CD33+HLA-DR- staining. MDSC subsets were further subdivided into granulocytic (G-, CD15+CD14-), monocytic (M-, CD15-CD14+), or early-MDSCs (e-, CD15-CD14-). RESULTS Blood samples were collected at indicated time points for four patients (FIGO stage IIA-IIB). Three had partial responses to chemoradiotherapy (CRT), while one had a complete response. All three patients with partial response had an increase in total frequency of circulating MDSCs in response to EBRT/BT (mean %fx MDSC 16.6 at T0 to 35.9 at T2), and an increase in total MDSCs in two of these patients occurred with EBRT alone. Interestingly, the patient that had a complete response had fewer MDSCs at T2 relative to T0 (35.8% at T0 to 27% at T2). Proportion of MDSC subsets varied considerably among the patients, and all had altered distribution of subsets in response to RT. G-MDSCs expanded the most to RT while M-MDSCs and e-MDSCs were less affected (mean fold change from T0 to T2 G-MDSC 4.75, M-MDSC 1.27, e-MDSC 0.942). CONCLUSION In this cohort of patients, an increase in MDSC frequency occurred after RT and altered subset distribution. Only the patient with a complete response had fewer total MDSCs following completion of CRT, suggesting further studies are needed to determine if circulating MDSCs could be a biomarker for treatment response to RT in cervical cancer.
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Affiliation(s)
- K Wanhainen
- University of Minnesota Medical School, Minneapolis, MN
| | - M Berkseth
- University of Minnesota, Minneapolis, MN
| | - N Sando
- University of Minnesota, Minneapolis, MN
| | - L Golden
- University of Minnesota, Minneapolis, MN
| | - A Techam
- M Health Fairview, Minneapolis, MN
| | | | | | - P Argenta
- University of Minnesota Medical School, Minneapolis, MN
| | - A O'Shea
- University of Minnesota Medical School, Minneapolis, MN
| | - C Rivard
- University of Minnesota Medical School, Minneapolis, MN
| | - R Ghebre
- University of Minnesota Medical School, Minneapolis, MN
| | - D Teoh
- University of Minnesota Medical School, Minneapolis, MN
| | - M A Reynolds
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | | | - J Yuan
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - L Sloan
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
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Sloan L, Sen R, Hu C, Liu C, Doucet M, Blosser L, Thompson E, Katulis L, Kamson D, Grossman S, Holdhoff M, Redmond K, Quon H, Lim M, Eberhart C, Pardoll D, Ganguly S, Kleinberg L. Radiation Immunodynamics as the Foundation of Immune-Guided Radiotherapy: Changes in Peripheral CD14+PD-L1+ Myeloid Cells over the Course of Chemoradiation and Association with Survival for New Diagnosis of Glioblastoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2090] [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]
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Zhang S, Reynolds M, Dusenbery K, Chen C, Alaei P, Alshreef A, Sterling D, Sloan L, Patel K, Ferreira C. Considerations in Treatment Planning and Dosimetric Specifications of Permanent 131Cs Brachytherapy Implantation in Treatment of Brain Tumor – An Institutional Experience. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2217] [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: 11/30/2022]
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Greenlund L, Mulford K, Shanley R, Neil E, Lawrence J, Arnold S, Olin M, Pluhar G, Venteicher A, Chen C, Ferreira C, Reynolds M, Cho L, Shoo A, Yuan J, Dusenbery K, Kleinberg L, Terezakis S, Wilke C, Sloan L. Hypofractionated vs. Conventionally Fractionated Radiotherapy for Glioblastoma: Peripheral Blood Leukocyte Comparison prior to and Following Chemoradiation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2080] [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: 10/31/2022]
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Deek M, Cecil E, Sloan L, Cheng Z, Han P, Sheikh K, Gui C, Guo Y, Lakshminarayanan P, Fakhry C, Koch W, Gourin C, Tan M, Mydlarz W, Schmitt N, McNutt T, Page B, Kiess A, Richmon J, Quon H. Definitive Management of Early Stage Oropharyngeal Carcinoma: A Comparison of Long Term Outcomes Following Transoral Surgery or Definitive Chemoradiation. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1516] [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]
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Cheng Z, Sheikh K, Lakshminarayanan P, Jiang W, Han P, Guo Y, Cecil E, Sloan L, Kiess A, Page B, Lee J, Quon H, McNutt T. Voxel Dose Pattern for Patient-Reported Dysphagia Among Head and Neck Cancer Patients Receiving Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.085] [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: 10/26/2022]
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Alcorn S, Fiksel J, Hu C, Wright J, Kleinberg L, Levin A, Smith T, Cheng Z, Elledge C, Kim K, Rao A, Sloan L, Page B, Stinson S, Voong R, McNutt T, Bowers M, DeWeese T, Zeger S. Pilot Assessment of the BMET Decision Support Platform: A Tool to Improve Provider Survival Estimates and Selection of Prognosis-Appropriate Treatment for Patients with Symptomatic Bone Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.474] [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: 10/26/2022]
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Sloan L, Sen R, Doucet M, Blosser L, Shpitser I, Cheng Z, Katulis L, Wemmer J, Jackson C, Hu C, McNutt T, Grossman S, Holdhoff M, Lim M, Redmond K, Eberhart C, Quon H, Pardoll D, Ganguly S, Kleinberg L. The Immunodynamics of Myeloid-Derived Suppressor Cell and Monocyte Populations in the Peripheral Blood in Patients with Newly Diagnosed Glioblastoma Undergoing Adjuvant Temozolomide and Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1029] [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: 10/26/2022]
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Sloan L, Terezakis S, Blakeley J, Slobogean B, Kleinberg L. Long-Term Outcomes of Radiation Therapy (RT) in the Management of Malignant Peripheral Nerve Sheath Tumors (MPNST) in Patients with Neurofibromatosis Type 1 (NF1). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deek M, Sloan L, Blackford A, Abrams R, Cecil E, Starmer H, Fakhry C, Gourin C, Kang H, Webster K, Richmon J, Chung C, Koch W, Kiess A, Sanguineti G, McNutt T, Forastiere A, Quon H. A Phase II Study of Radiation Therapy Deintensification for HPV-Associated Oropharyngeal Carcinomas: Long-Term Oncologic and Toxicity Results. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.094] [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: 10/28/2022]
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Runge T, Briceño T. J, Sheller M, Moritz C, Sloan L, Bohls F, Ottmers S. Hemodialysis: Evidence of Enhanced Molecular Clearance and Ultrafiltration Volume by Using Pulsatile Flow. Int J Artif Organs 2018. [DOI: 10.1177/039139889301600904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe several in vitro experiments showing evidence that pulsatile flow hemodialysis enhances ultrafiltration volume and molecular clearance as compared with steady flow hemodialysis. A new pulsatile pump and a conventional roller pump were compared using different hollow fiber dialyzers and a simulated blood solution containing urea, aspartame and vitamin B-12 at different flow rates and configurations. Ultrafiltration volume and concentration of urea, aspartame and B-12 were measured and molecular clearance (K) calculated. Ultrafiltration volume markedly increased with pulsatile flow. After 10 min K for urea with pulsatile flow was higher in all experiments even when ultrafiltration was prevented. Clearance of aspartame and B-12 also increased with pulsatile flow. We propose three mechanisms by which pulsatile flow is more efficient than steady flow hemodialysis: greater fluid energy, avoidance of molecular channeling and avoidance of membrane layering. We hypothesize that using pulsatile flow in hemodialysis can significantly shorten the duration of dialysis sessions for most of the patients, and consequently reduce the duration of the procedure and its cost.
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Affiliation(s)
- T.M. Runge
- Department of Medicine and Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Biomedical Engineering Program, The University of Texas at Austin, Austin, Texas - USA
| | - J.C. Briceño T.
- Biomedical Engineering Program, The University of Texas at Austin, Austin, Texas - USA
| | - M.E. Sheller
- Biomedical Engineering Program, The University of Texas at Austin, Austin, Texas - USA
| | - C.E. Moritz
- Department of Medicine and Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - L. Sloan
- Department of Medicine and Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - F.O. Bohls
- Biomedical Engineering Program, The University of Texas at Austin, Austin, Texas - USA
| | - S.E. Ottmers
- Biomedical Engineering Program, The University of Texas at Austin, Austin, Texas - USA
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Sloan L, Lin D, Shen C, Redmond K, Bettegowda C, Grimm J, Link K, Lim M, Kleinberg L. Rate of Intralesional Hemorrhage in Hypofractionated Stereotactic Radiosurgery for Brain Metastases in Patients with Metastatic Melanoma Treated with Concurrent Immunotherapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.854] [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: 10/18/2022]
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Grimm J, Shen C, Redmond K, Sloan L, Hazell S, Chan L, Seo Y, Nikolaidis D, Moore J, Huang E, Quon H, Bettegowda C, Lim M, Kleinberg L. Low Risk of Symptomatic Radionecrosis Following Stereotactic Radiosurgery for Multiple Brain Metastases. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Margolis DA, Gonzalez-Garcia J, Stellbrink HJ, Eron JJ, Yazdanpanah Y, Podzamczer D, Lutz T, Angel JB, Richmond GJ, Clotet B, Gutierrez F, Sloan L, Clair MS, Murray M, Ford SL, Mrus J, Patel P, Crauwels H, Griffith SK, Sutton KC, Dorey D, Smith KY, Williams PE, Spreen WR. Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial. Lancet 2017; 390:1499-1510. [PMID: 28750935 DOI: 10.1016/s0140-6736(17)31917-7] [Citation(s) in RCA: 341] [Impact Index Per Article: 48.7] [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: 06/02/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cabotegravir and rilpivirine are antiretroviral drugs in development as long-acting injectable formulations. The LATTE-2 study evaluated long-acting cabotegravir plus rilpivirine for maintenance of HIV-1 viral suppression through 96 weeks. METHODS In this randomised, phase 2b, open-label study, treatment-naive adults infected with HIV-1 initially received oral cabotegravir 30 mg plus abacavir-lamivudine 600-300 mg once daily. The objective of this study was to select an intramuscular dosing regimen based on a comparison of the antiviral activity, tolerability, and safety of the two intramuscular dosing regimens relative to oral cabotegravir plus abacavir-lamivudine. After a 20-week induction period on oral cabotegravir plus abacavir-lamivudine, patients with viral suppression (plasma HIV-1 RNA <50 copies per mL) were randomly assigned (2:2:1) to intramuscular long-acting cabotegravir plus rilpivirine at 4-week intervals (long-acting cabotegravir 400 mg plus rilpivirine 600 mg; two 2 mL injections) or 8-week intervals (long-acting cabotegravir 600 mg plus rilpivirine 900 mg; two 3 mL injections) or continued oral cabotegravir plus abacavir-lamivudine. Randomisation was computer-generated with stratification by HIV-1 RNA (<50 copies per mL, yes or no) during the first 12 weeks of the induction period. The primary endpoints were the proportion of patients with viral suppression at week 32 (as defined by the US Food and Drug Administration snapshot algorithm), protocol-defined virological failures, and safety events through 96 weeks. All randomly assigned patients who received at least one dose of study drug during the maintenance period were included in the primary efficacy and safety analyses. The primary analysis used a Bayesian approach to evaluate the hypothesis that the proportion with viral suppression for each long-acting regimen is not worse than the oral regimen proportion by more than 10% (denoted comparable) according to a prespecified decision rule (ie, posterior probability for comparability >90%). Difference in proportions and associated 95% CIs were supportive to the primary analysis. The trial is registered at ClinicalTrials.gov, number NCT02120352. FINDINGS Among 309 enrolled patients, 286 were randomly assigned to the maintenance period (115 to each of the 4-week and 8-week groups and 56 to the oral treatment group). This study is currently ongoing. At 32 weeks following randomisation, both long-acting regimens met primary criteria for comparability in viral suppression relative to the oral comparator group. Viral suppression was maintained at 32 weeks in 51 (91%) of 56 patients in the oral treatment group, 108 (94%) of 115 patients in the 4-week group (difference 2·8% [95% CI -5·8 to 11·5] vs oral treatment), and 109 (95%) of 115 patients in the 8-week group (difference 3·7% [-4·8 to 12·2] vs oral treatment). At week 96, viral suppression was maintained in 47 (84%) of 56 patients receiving oral treatment, 100 (87%) of 115 patients in the 4-week group, and 108 (94%) of 115 patients in the 8-week group. Three patients (1%) experienced protocol-defined virological failure (two in the 8-week group; one in the oral treatment group). Injection-site reactions were mild (3648 [84%] of 4360 injections) or moderate (673 [15%] of 4360 injections) in intensity and rarely resulted in discontinuation (two [<1%] of 230 patients); injection-site pain was reported most frequently. Serious adverse events during maintenance were reported in 22 (10%) of 230 patients in the intramuscular groups (4-week and 8-week groups) and seven (13%) of 56 patients in the oral treatment group; none were drug related. INTERPRETATION The two-drug combination of all-injectable, long-acting cabotegravir plus rilpivirine every 4 weeks or every 8 weeks was as effective as daily three-drug oral therapy at maintaining HIV-1 viral suppression through 96 weeks and was well accepted and tolerated. FUNDING ViiV Healthcare and Janssen R&D.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bonaventura Clotet
- Hospital Germans Trias i Pujol, UAB, UVIC-UCC, Badalona, Catalonia, Spain
| | - Felix Gutierrez
- Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
| | - Louis Sloan
- North Texas Infectious Disease Consultants, Dallas, TX, USA
| | | | | | - Susan L Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Joseph Mrus
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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Dejesus E, Elion R, Ramgopal M, Wade BH, Sloan L, Edelstein H, Pierone G, Slim J, Stephens J, Yan M, Tran-Muchowski C, Rhee M. Efficacy and Safety of Tenofovir Alafenamide versus Tenofovir Disoproxil Fumarate in HIV-infected, Virologically Suppressed Black and Non-Blacks Adults Through Week 48: Subgroup Analysis of a Randomized Switch Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1210] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Moti Ramgopal
- Midway Immunology and Research Center, Fort Pierce, FL
| | - Barbara H. Wade
- Center for the Prevention and Treatment of Infections, Pensacola, FL
| | - Louis Sloan
- North Texas Infectious Diseases Consultants PA, Dallas, TX
| | | | - Gerald Pierone
- AIDS Research and Treatment Center of the Treasure Coast, Vero Beach, FL
| | - Jihad Slim
- Saint. Michael's Medical Center, Newark, NJ
| | | | - Mingjin Yan
- Biostatistics, Gilead Sciences, Inc., Foster City, CA
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Lévy Y, Thiébaut R, Montes M, Lacabaratz C, Sloan L, King B, Pérusat S, Harrod C, Cobb A, Roberts LK, Surenaud M, Boucherie C, Zurawski S, Delaugerre C, Richert L, Chêne G, Banchereau J, Palucka K. Dendritic cell-based therapeutic vaccine elicits polyfunctional HIV-specific T-cell immunity associated with control of viral load. Eur J Immunol 2014; 44:2802-10. [PMID: 25042008 DOI: 10.1002/eji.201344433] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 05/22/2014] [Accepted: 07/10/2014] [Indexed: 02/02/2023]
Abstract
Efforts aimed at restoring robust immune responses limiting human immunodeficiency virus (HIV)-1 replication therapeutically are warranted. We report that vaccination with dendritic cells generated ex vivo and loaded with HIV lipopeptides in patients (n = 19) on antiretroviral therapy was well tolerated and immunogenic. Vaccination increased: (i) the breadth of the immune response from 1 (1-3) to 4 (2-5) peptide-pool responses/patient (p = 0.009); (ii) the frequency of functional T cells (producing at least two cytokines among IFN-γ, TNF-α, and IL-2) from 0.026 to 0.32% (p = 0.002) and from 0.26 to 0.35% (p = 0.005) for CD4(+) and CD8(+) T cells, respectively; and (iii) the breadth of cytokines secreted by PBMCs upon antigen exposure, including IL-2, IFN-γ, IL-21, IL-17, and IL-13. Fifty percent of patients experienced a maximum of viral load (VL) 1 log10 lower than the other half following antiretroviral treatment interruption. An inverse correlation was found between the maximum of VL and the frequency of polyfunctional CD4(+) T cells (p = 0.007), production of IL-2 (p = 0.006), IFN-γ (p = 0.01), IL-21 (p = 0.006), and IL-13 (p = 0.001). These results suggest an association between vaccine responses and a better control of viral replication. These findings will help in the development of strategies for a functional cure for HIV infection.
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Affiliation(s)
- Yves Lévy
- INSERM, Unite, Creteil, France; Universite Paris-Est, Creteil, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Henri-Mondor Albert-Chenevier, service d'immunologie clinique, Creteil, France; Vaccine Research Institute (VRI), Creteil, France
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Davids MR, Marais N, Jacobs J, Cohen E, Krause I, Goldberg E, Garty M, Krause I, Dursun B, Sahan Y, Tanriverdi H, Rota S, Uslu S, Senol H, Minutolo R, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Stanzione G, Nappi F, Bellizzi V, Conte G, De Nicola L, Van De Walle J, Johnson S, Fremeaux-Bacchi V, Ardissino G, Ariceta G, Beauchamp J, Cohen D, Greenbaum LA, Ogawa M, Schaefer F, Licht C, Scalzotto E, Nalesso F, Zaglia T, Corradi V, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Chinnappa S, Mooney A, El Nahas AM, Tu YK, Tan LB, Jung JY, Kim AJ, Ro H, Lee C, Chang JH, Lee HH, Chung W, Clarke AL, Young HM, Hull KL, Hudson N, Burton JO, Smith AC, Marx S, Petrilla A, Filipovic I, Lee WC, Meijers B, Poesen R, Storr M, Claes K, Kuypers D, Evenepoel P, Aukland M, Clarke AL, Hull KL, Burton JO, Smith AC, Betriu A, Martinez-Alonso M, Arcidiacono MV, Cannata-Andia J, Pascual J, Valdivielso JM, Fernandez-Giraldez E, Kingswood JC, Zonnenberg B, Sauter M, Zakar G, Biro B, Besenczi B, Varga A, Pekacs P, Pizzini P, Pisano A, Leonardis D, Panuccio V, Cutrupi S, Tripepi G, Mallamaci F, Zoccali C, Arnold J, Baharani J, Rayner H, So BH, Blackwell S, Jardine AG, Macgregor MS, Cunha C, Barreto P, Pereira S, Ventura A, Mota M, Seabra J, Sakaguchi T, Kobayashi S, Yano T, Yoshimoto W, Bancu I, Bonal Bastons J, Cleries Escayola M, Vela Vallespin E, Bustins Poblet M, Magem Luque D, Pastor Fabregas M, Chen JH, Chen SC, Chang JM, Hwang SJ, Chen HC, Ahbap E, Kara E, Basturk T, Sahutoglu T, Koc Y, Sakaci T, Sevinc M, Akgol C, Ozagari AA, Unsal A, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Marks A, Fluck N, Prescott G, Robertson L, Smith WC, Black C, Ohsawa M, Fujioka T, Omori S, Isurugi T, Tanno K, Onoda T, Omama S, Ishibashi Y, Makita S, Okayama A, Garland JS, Simpson CS, Metangi MF, Parfrey B, Johri AM, Sloan L, McAuley J, Cunningham R, Mullan R, Quinn M, Harron C, Chiu H, Murphy-Burke D, Werb R, Jung B, Chan-Yan C, Duncan J, Forzley B, Lowry R, Hargrove G, Carson R, Levin A, Karim M, Reznik EV, Storozhakov GIV, Rollino C, Troiano M, Bagatella M, Liuzzo C, Quarello F, Roccatello D, Blaslov K, Bulum T, Prka In I, Duvnjak L, Heleniak Z, Ciepli ska M, Szychli ski T, Pryczkowska M, Bartosi ska E, Wiatr H, Kot owska H, Tylicki L, Rutkowski B, Song YR, Kim SGK, Kim HJ, Noh JW, Tong A, Jesudason S, Craig JC, Winkelmayer WC, Hung PH, Huang YT, Hsiao CY, Sung PS, Guo HR, Tsai KJ, Wu CC, Su SL, Kao SY, Lu KC, Lin YF, Lin WH, Lee HM, Cheng MF, Wang WM, Yang LY, Wang MC, Vukovic Lela I, Sekoranja M, Poljicanin T, Karanovic S, Abramovic M, Matijevic V, Stipancic Z, Leko N, Cvitkovic A, Dika Z, Kos J, Laganovic M, Grollman AP, Jelakovic B, Dryl-Rydzynska T, Prystacki T, Malyszko J, Trifiro G, Sultana J, Giorgianni F, Ingrasciotta Y, Muscianisi M, Tari DU, Perrotta M, Buemi M, Canale V, Arcoraci V, Santoro D, Rizzo M, Iheanacho I, Van Nooten FE, Goldsmith D, Grandtnerova B, Berat ova Z, ErvenOva M, cErven J, Markech M, tefanikova A, Engelen W, Elseviers M, Gheuens E, Colson C, Muyshondt I, Daelemans R. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Flamar AL, Xue Y, Zurawski SM, Montes M, King B, Sloan L, Oh S, Banchereau J, Levy Y, Zurawski G. Targeting concatenated HIV antigens to human CD40 expands a broad repertoire of multifunctional CD4+ and CD8+ T cells. AIDS 2013; 27:2041-51. [PMID: 23615121 DOI: 10.1097/qad.0b013e3283624305] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Targeting HIV antigens directly to dendritic cells using monoclonal antibodies against cell-surface receptors has been shown to evoke potent cellular immunity in animal models. The objective of this study was to configure an anti-human CD40 antibody fused to a string of five highly conserved CD4 and CD8 T-cell epitope-rich regions of HIV-1 Gag, Nef and Pol (αCD40.HIV5pep), and then to demonstrate the capacity of this candidate therapeutic vaccine to target these HIV peptide antigens to human dendritic cells to expand functional HIV-specific T cells. METHODS Antigen-specific cytokine production using intracellular flow cytometry and multiplex bead-based assay, and suppression of viral inhibition, were used to characterize the T cells expanded by αCD40.HIV5pep from HIV-infected patient peripheral blood mononuclear cell (PBMC) and dendritic cell/T-cell co-cultures. RESULTS This candidate vaccine expands memory CD4 and CD8 T cells specific to multiple epitopes within all five peptide regions across a wide range of major histocompatibility complex (MHC) haplotypes from HIV-infected patient PBMC and dendritic cell/T-cell co-cultures. These in vitro expanded HIV antigen-specific CD4 and CD8 T cells produce multiple cytokines and chemokines. αCD40.HIV5pep-expanded CD8 T cells have characteristics of cytotoxic effector cells and are able to kill autologous target cells and suppress HIV-1 replication in vitro. CONCLUSION Our data demonstrate the therapeutic potential of this CD40-targeting HIV candidate vaccine in inducing a broad repertoire of multifunctional T cells in patients.
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Abstract
A case of herpes simplex virus (HSV) meningitis complicated by ascending paralysis with almost complete recovery following antiviral treatment is reported. We present this case to illustrate the importance of including HSV-induced neuropathy in the differential diagnosis of acute neurologic symptoms following the viral illness.
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Affiliation(s)
- Mina M Benjamin
- Department of Internal Medicine (Benjamin, Gummelt, Zaki [extern], Afzal), Divisions of Infectious Diseases (Sloan) and Neurology (Shamim), Baylor University Medical Center at Dallas
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Kumar P, DeJesus E, Huhn G, Sloan L, Small CB, Edelstein H, Felizarta F, Hao R, Ross L, Stancil B, Pappa K, Ha B. Evaluation of cardiovascular biomarkers in a randomized trial of fosamprenavir/ritonavir vs. efavirenz with abacavir/lamivudine in underrepresented, antiretroviral-naïve, HIV-infected patients (SUPPORT): 96-week results. BMC Infect Dis 2013; 13:269. [PMID: 23741991 PMCID: PMC3685599 DOI: 10.1186/1471-2334-13-269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/24/2013] [Indexed: 01/11/2023] Open
Abstract
Background Rates of cardiovascular disease are higher among HIV-infected patients as a result of the complex interplay between traditional risk factors, HIV-related inflammatory and immunologic changes, and effects of antiretroviral therapy (ART). This study prospectively evaluated changes in cardiovascular biomarkers in an underrepresented, racially diverse, HIV-1-infected population receiving abacavir/lamivudine as backbone therapy. Methods This 96-week, open-label, randomized, multicenter study compared once-daily fosamprenavir/ritonavir 1400/100 mg and efavirenz 600 mg, both with ABC/3TC 600 mg/300 mg, in antiretroviral-naïve, HLA-B*5701-negative adults without major resistance mutations to study drugs. We evaluated changes from baseline to weeks 4, 12, 24, 48, and 96 in interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble vascular adhesion molecule-1 (sVCAM-1), d-dimer, plasminogen, and fibrinogen. Biomarker data were log-transformed before analysis, and changes from baseline were described using geometric mean ratios. Results This study enrolled 101 patients (51 receiving fosamprenavir/ritonavir; 50 receiving efavirenz): 32% female, 60% African American, and 38% Hispanic/Latino; 66% (67/101) completed 96 weeks on study. At week 96, levels of IL-6, sVCAM-1, d-dimer, fibrinogen, and plasminogen were lower than baseline in both treatment groups, and the decrease was statistically significant for sVCAM-1 (fosamprenavir/ritonavir and efavirenz), d-dimer (fosamprenavir/ritonavir and efavirenz), fibrinogen (efavirenz), and plasminogen (efavirenz). Values of hs-CRP varied over time in both groups, with a significant increase over baseline at Weeks 4 and 24 in the efavirenz group. At week 96, there was no difference between the groups in the percentage of patients with HIV-1 RNA <50 copies/mL (fosamprenavir/ritonavir 63%; efavirenz 66%) by ITT missing-equals-failure analysis. Treatment-related grade 2–4 adverse events were more common with efavirenz (32%) compared with fosamprenavir/ritonavir (20%), and median lipid concentrations increased in both groups over 96 weeks of treatment. Conclusions In this study of underrepresented patients, treatment with abacavir/lamivudine combined with either fosamprenavir/ritonavir or efavirenz over 96 weeks, produced stable or declining biomarker levels except for hs-CRP, including significant and favorable decreases in thrombotic activity (reflected by d-dimer) and endothelial activation (reflected by sVCAM-1). Our study adds to the emerging data that some cardiovascular biomarkers are decreased with initiation of ART and control of HIV viremia. Trial registration ClinicalTrials.gov identifier NCT00727597
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Levy Y, Thiébaut R, Montes M, Lacabaratz C, Sloan L, Perusat S, Harrod C, Boucherie C, Zurawski S, Richert L, Chêne G, Banchereau J, Palucka K. Vaccination with dendritic cells loaded with HIV-1 lipopeptides elicits broad T cell immunity and control of viral load in HIV infected patients. Retrovirology 2012. [PMCID: PMC3441715 DOI: 10.1186/1742-4690-9-s2-p328] [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: 11/10/2022] Open
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Cobb A, Roberts LK, Palucka AK, Mead H, Montes M, Ranganathan R, Burkeholder S, Finholt JP, Blankenship D, King B, Sloan L, Harrod AC, Lévy Y, Banchereau J. Development of a HIV-1 lipopeptide antigen pulsed therapeutic dendritic cell vaccine. J Immunol Methods 2011; 365:27-37. [DOI: 10.1016/j.jim.2010.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
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Kumar P, DeJesus E, Huhn G, Sloan L, Garcia F, Small C, Edelstein H, Felizarta F, Hao R, Ha B, Stancil B, Ross L, Oie K, Pappa K. SUPPORT: 48-week results of fosamprenavir/ritonavir vs efavirenz with abacavir/lamivudine in under-represented, antiretroviral-naïve patients. J Int AIDS Soc 2010. [PMCID: PMC3113075 DOI: 10.1186/1758-2652-13-s4-p7] [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: 11/23/2022] Open
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González-García J, Cohen D, Johnson M, Sloan L, Fredrick L, Naylor C, da Silva B, Bernstein B. Short communication: Comparable safety and efficacy with once-daily versus twice-daily dosing of lopinavir/ritonavir tablets with emtricitabine + tenofovir DF in antiretroviral-naïve, HIV type 1-infected subjects: 96 week final results of the randomized trial M05-730. AIDS Res Hum Retroviruses 2010; 26:841-5. [PMID: 20672994 DOI: 10.1089/aid.2009.0307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sustained viral suppression with antiretroviral therapy improves clinical outcomes for HIV-infected individuals. Study M05-730 evaluated the long-term antiviral activity, safety, tolerability, emergence of resistance, and compliance with once-daily (QD) versus twice-daily (BID) lopinavir/ritonavir (LPV/r) combination therapy in treatment-naïve, HIV-1-infected subjects through 96 weeks. Antiretroviral-naïve subjects with HIV-1 RNA levels >1000 copies/ml were randomized to LPV/r QD (N = 333) or BID (N = 331) with tenofovir DF and emtricitabine. Through 96 weeks, 77 subjects from each group discontinued prematurely; adverse or HIV-related events contributed to discontinuation of 36 subjects overall, with no significant differences between treatment groups. At 96 weeks, 216 QD subjects (64.9%) and 229 BID subjects (69.2%) had HIV-1 RNA <50 copies/ml (p = 0.249) by intent-to-treat analysis. Evaluation of the time to virologic failure indicated that 85.0% and 80.7% of QD and BID subjects, respectively, maintained virologic suppression through 96 weeks (p = 0.638). QD subjects demonstrated greater adherence levels. There were no significant differences in virologic response when subjects were analyzed according to baseline disease state. Emergence of postbaseline resistance mutations occurred at similar low rates in each dosing group. Diarrhea was the most common moderate-to-severe drug-related adverse event reported; the most common Grade 3+ laboratory abnormalities were elevations of total cholesterol and triglycerides, occurring with similar incidence regardless of LPV/r dosing frequency. QD dosing of LPV/r was associated with similar durability of viral suppression and low rates of genotypic resistance and treatment-limiting adverse events as compared with BID dosing in treatment-naïve subjects through 96 weeks of treatment.
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Affiliation(s)
| | | | | | - Louis Sloan
- North Texas Infectious Disease Consultants, Dallas, Texas
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Loof N, Montes M, Flamar A, Zurawski G, Cobb A, Plants J, King B, Zurawski S, Sloan L, Levy Y, Banchereau J. S04-04 OA. HIV-specific responses induced by anti-CD40 targeting antibodies. Retrovirology 2009. [PMCID: PMC2767569 DOI: 10.1186/1742-4690-6-s3-o46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Flamar A, Zurawski S, Cobb A, King B, Sloan L, Levy Y, Banchereau J, Zurawski G. P17-04. Targeting HIV peptides to human dendritic cells via CD40 elicits expansion of multi-epitope polyfunctional CD4+ and CD8+ T cells in HIV patients. Retrovirology 2009. [PMCID: PMC2767788 DOI: 10.1186/1742-4690-6-s3-p286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Banchereau J, Harrod C, Cobb A, Chene G, Sloan L, Palucka K, Levy Y. P18-11. DALIA: dendritic cell and lipopeptide-induced immunity against AIDS: a phase I trial. Retrovirology 2009. [PMCID: PMC2767827 DOI: 10.1186/1742-4690-6-s3-p320] [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: 12/02/2022] Open
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Montes M, Loof N, Cobb A, Jutras D, Quinn C, Plants J, Zurawski S, King B, Sloan L, Levy Y, Banchereau J. P16-49. Broad types of cytokines secreted by Gag-specific T cells from HIV infected patients on HAART. Retrovirology 2009. [PMCID: PMC2767779 DOI: 10.1186/1742-4690-6-s3-p278] [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: 11/10/2022] Open
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Montes M, Loof N, Cobb A, Jutras D, Queen C, Plants J, King B, Zurawski S, Sloan L, Levy Y, Banchereau J. P16-29. HIV Nef-specific T cells: Th1/CTL, Th2 and Th17 responses. Retrovirology 2009. [PMCID: PMC2767757 DOI: 10.1186/1742-4690-6-s3-p258] [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: 11/10/2022] Open
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Flamar AL, Lévy Y, Cobb A, Montes M, King B, Sloan L, Banchereau J, Zurawski G. T.85. Development of Prototype Vaccines that Target HIV Antigens to Human Dendritic Cells. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.220] [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: 11/25/2022]
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Currier J, Lazzarin A, Sloan L, Clumeck N, Slim J, McCarty D, Steel H, Kleim JP, Bonny T, Millard J. Antiviral Activity and Safety of Aplaviroc with Lamivudine/Zidovudine in HIV-Infected, Therapy-Naive Patients: The ASCENT (CCR102881) Study. Antivir Ther 2008. [DOI: 10.1177/135965350801300204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background This Phase IIb study explored the antiviral activity and safety of the investigational CCR5 antagonist aplaviroc (APL) in antiretroviral-naive patients harbouring R5-tropic virus. Methods One hundred and forty-seven patients were randomized 2:2:1 to one of two APL dosing regimens or efavirenz (EFV). All dosage arms were administered twice daily and in combination with lamivudine/zidovudine (3TC/ZDV; Combivir, COM). Efficacy, safety, and pharmacokinetic parameters were assessed. Results This study was prematurely terminated due to APL-associated idiosyncratic hepatotoxicity. The primary endpoint of the study was the proportion of patients with plasma HIV-1 RNA <400 copies/ml who remained on randomized treatment through week 12. Of the 147 patients enrolled, 145 patients received one dose of treatment and were included in the intention-to-treat population. The proportion of patients with HIV-1 RNA <400 copies/ml at week 12 was 53%, 50% and 66% in the APL 600 mg twice daily, APL 800 mg twice daily, and EFV arms, respectively. Common clinical adverse events (AEs) were diarrhoea, nausea, fatigue and headache. APL demonstrated non-linear pharmacokinetics with high interpatient variability. In addition to the hepatic findings, there was an apparent dose–response relationship in the incidence of diarrhoea. Conclusions Whereas target plasma concentrations of APL were achieved, the antiviral activity of APL as the third agent in a triple drug regimen did not appear to be comparable to EFV in this treatment-naive patient population.
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Affiliation(s)
| | | | | | - Louis Sloan
- North Texas Disease Consultants, Dallas, TX, USA
| | | | - Jihad Slim
- St. Michael's Medical Center, Newark, NJ, USA
| | - Deb McCarty
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | - Tab Bonny
- W. L. Gore and Associates, Flagstaff, AZ, USA
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Currier J, Lazzarin A, Sloan L, Clumeck N, Slims J, McCarty D, Steel H, Kleim JP, Bonny T, Millard J. Antiviral activity and safety of aplaviroc with lamivudine/zidovudine in HIV-infected, therapy-naive patients: the ASCENT (CCR102881) study. Antivir Ther 2008; 13:297-306. [PMID: 18505181] [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: 05/26/2023]
Abstract
BACKGROUND This Phase IIb study explored the antiviral activity and safety of the investigational CCR5 antagonist aplaviroc (APL) in antiretroviral-naive patients harbouring R5-tropic virus. METHODS One hundred and forty-seven patients were randomized 2:2:1 to one of two APL dosing regimens or efavirenz (EFV). All dosage arms were administered twice daily and in combination with lamivudine/zidovudine (3TC/ZDV; Combivir, COM). Efficacy, safety, and pharmacokinetic parameters were assessed. RESULTS This study was prematurely terminated due to APL-associated idiosyncratic hepatotoxicity. The primary endpoint of the study was the proportion of patients with plasma HIV-1 RNA <400 copies/ml who remained on randomized treatment through week 12. Of the 147 patients enrolled, 145 patients received one dose of treatment and were included in the intention-to-treat population. The proportion of patients with HIV-1 RNA <400 copies/ml at week 12 was 53%, 50% and 66% in the APL 600 mg twice daily, APL 800 mg twice daily, and EFV arms, respectively. Common clinical adverse events (AEs) were diarrhoea, nausea, fatigue and headache. APL demonstrated non-linear pharmacokinetics with high interpatient variability. In addition to the hepatic findings, there was an apparent dose-response relationship in the incidence of diarrhoea. CONCLUSIONS Whereas target plasma concentrations of APL were achieved, the antiviral activity of APL as the third agent in a triple drug regimen did not appear to be comparable to EFV in this treatment-naive patient population.
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Rodriguez A, Hill-Zabala C, Sloan L, Jefferson T, Yau L, Watson M, Irlbeck D, Shaefer M. Patients Experiencing Early Virologic Failure on a Protease Inhibitor- or Nonnucleoside Reverse Transcriptase Inhibitor-Based Initial Regimen Containing a Thymidine Analogue and Lamivudine Can Be Successfully Treated With a Quadruple-Nucleoside Regimen. J Acquir Immune Defic Syndr 2006; 41:127-9. [PMID: 16340487 DOI: 10.1097/01.qai.0000191999.77658.6e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gross AM, Bennett T, Sloan L, Marx BP, Juergens J. The impact of alcohol and alcohol expectancies on male perception of female sexual arousal in a date rape analog. Exp Clin Psychopharmacol 2002. [PMID: 11764014 DOI: 10.1037//1064-1297.9.4.380] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The impact of alcohol and alcohol expectancies on men's perception of female sexual arousal and men's ability to discriminate accurately female sexual intentions in a dating situation was examined. In a 2 (alcohol) x 2 (expectancy) balanced placebo design, men were exposed to an audiotape of a date rape and asked to signal when the man should stop making sexual advances. On 4 occasions during the vignette, participants rated how sexually aroused the woman on the tape was at that moment. Relative to controls, participants who consumed alcohol or expected to consume alcohol took significantly longer to identify the inappropriateness of the man's sexual behavior toward his date. Similarly, alcohol participants also rated the woman's arousal level significantly higher at the first 2 refusals. Implications of the results are discussed.
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Affiliation(s)
- A M Gross
- Department of Psychology, University of Mississippi, University 38677, USA.
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Abstract
Since 65 million years ago (Ma), Earth's climate has undergone a significant and complex evolution, the finer details of which are now coming to light through investigations of deep-sea sediment cores. This evolution includes gradual trends of warming and cooling driven by tectonic processes on time scales of 10(5) to 10(7) years, rhythmic or periodic cycles driven by orbital processes with 10(4)- to 10(6)-year cyclicity, and rare rapid aberrant shifts and extreme climate transients with durations of 10(3) to 10(5) years. Here, recent progress in defining the evolution of global climate over the Cenozoic Era is reviewed. We focus primarily on the periodic and anomalous components of variability over the early portion of this era, as constrained by the latest generation of deep-sea isotope records. We also consider how this improved perspective has led to the recognition of previously unforeseen mechanisms for altering climate.
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Affiliation(s)
- J Zachos
- Earth Sciences Department, University of California, Santa Cruz, CA 95064, USA.
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Abstract
A survey of licensed social workers in Texas using self-administered questionnaires revealed that, during the previous 12 months, 17 percent had worked with at least one victim of sexual exploitation by a psychotherapist. Social workers licensed as advanced clinical practitioners, licensed social workers with master's degrees, and those working in private practice were most likely to have worked with a victim of such sexual exploitation. Most respondents were not familiar with the provisions of new Texas legislation concerning sexual exploitation by psychotherapists, including definitions and reporting requirements. The majority indicated they would be interested in additional training.
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Affiliation(s)
- L Sloan
- Graduate School of Social Work, University of Houston, TX 77204, USA
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Spencer JM, Tannenbaum A, Sloan L, Amonette RA. Does inflammation contribute to the eradication of basal cell carcinoma following curettage and electrodesiccation? Dermatol Surg 1997; 23:625-30; discussion 630-1. [PMID: 9256908 DOI: 10.1111/j.1524-4725.1997.tb00379.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Curettage and electrodesiccation (C&D) is probably the technique most frequently utilized by dermatologists to treat basal cell carcinomas (BCC). From histologic studies, it appears C&D does not completely mechanically remove all nests of BCC in a substantial number of cases. Nevertheless, the reported 5-year reoccurrence rate following C&D is significantly less than this histologically observed residual tumor frequency immediately following C&D. Among the multiple possibilities that exist to explain why these residual nests do not appear as recurrent tumor more frequently is the theory that inflammation developing after C&D clears residual tumor. OBJECTIVE To test the hypothesis that inflammation developing after C&D clears residual tumor not mechanically removed by the procedure. METHODS The frequency of residual BCC detected histologically immediately following C&D was compared with the frequency 1 month after the C&D, an amount of time in which an effect (if any) of inflammation could occur. RESULTS Twenty-two of 29 primary BCC < 1 cm treated by C&D were tumor free immediately following the procedure (clearance rate, 75.9%). Eleven of 14 primary BCC < 1 cm treated by C&D then allowed to granulate 1 month before excision and histologic analysis were tumor free, for a clearance rate of 78.6%. Examination of larger tumors immediately following C&D revealed size is a significant variable for clearance rates. Eleven primary BCC > 1 cm but < 2 cm were examined histologically immediately following C&D; only three were tumor free for a clearance rate of 27.3%. Only one of five tumors > 2 cm thus treated was tumor free, for a clearance rate of 20%. Nine recurrent BCC of various sizes were treated by C&D and immediately examined histologically. Two were tumor free for a clearance rate of 22.2%. Two recurrent BCC were allowed to heal 1 month following C&D; one of these was tumor free when excised. CONCLUSION For primary BCC < 1 cm, no evidence was found that inflammation occurring over 1 month following C&D clears residual tumor. It was also noted that C&D fails to completely remove tumor in a large majority of primary BCC > 1 cm, and in recurrent BCC.
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Affiliation(s)
- J M Spencer
- Division of Dermatology, University of Tennessee, Memphis, USA
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Abstract
We evaluated a commercially available enzyme-linked immunoassay (ELISA) from LMD Laboratories, Inc., Carlsbad, Calif., for the detection of antibodies in serum to the cysticercus of Taenia solium. The ELISA was performed on 308 serum samples; 198 from a pool of healthy individuals, 42 from patients who had antibodies against a variety of parasites other than T. solium, and 68 from patients suspected of having cysticercosis. All of these 68 specimens were tested both by the ELISA and by an immunoblot method (enzyme-linked immunoelectrotransfer blot assay [EITB]) developed at the Parasitic Serology Laboratory of the Centers for Disease Control and Prevention. Twenty-seven of the 68 serum samples from patients suspected of having cysticercosis were positive by both EITB and ELISA, while 31 were negative by both assays. ELISA results for three and two samples were considered false positive and false negative, respectively, when compared with the results of EITB. Results for an additional five samples were considered equivocal but were technically positive because their optical density readings were slightly above the cutoff value. Three of the 198 serum samples from the bank of serum samples from healthy individuals were also false positive by ELISA (the EITB result for the samples was negative). Six other serum samples from healthy individuals which had equivocal results and the five serum samples from patients with equivocal results were EITB negative. Serum samples containing antibodies against Echinococcus spp. frequently cross-reacted with the cysticercus ELISA antigen (13 of 16 specimens), but serum samples with antibodies against other parasites did not (2 of 26 specimens); all of these serum samples were EITB negative. The commercially available ELISA that we describe is a simple and rapid test. Considering all 308 specimens, the ELISA had a specificity of 93% (when samples with equivocal results were considered negative) or 89% (when samples with equivocal results were considered positive); the sensitivity was 93%.
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Affiliation(s)
- L Sloan
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Sloan L. Response to article "Should nurses be unionized". AARN News Lett 1994; 50:7-8. [PMID: 7887086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Runge TM, Briceño JC, Sheller ME, Moritz CE, Sloan L, Bohls FO, Ottmers SE. Hemodialysis: evidence of enhanced molecular clearance and ultrafiltration volume by using pulsatile flow. Int J Artif Organs 1993; 16:645-52. [PMID: 8294156] [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: 01/29/2023]
Abstract
We describe several in vitro experiments showing evidence that pulsatile flow hemodialysis enhances ultrafiltration volume and molecular clearance as compared with steady flow hemodialysis. A new pulsatile pump and a conventional roller pump were compared using different hollow fiber dialyzers and a simulated blood solution containing urea, aspartame and vitamin B-12 at different flow rates and configurations. Ultrafiltration volume and concentration of urea, aspartame and B-12 were measured and molecular clearance (K) calculated. Ultrafiltration volume markedly increased with pulsatile flow. After 10 min K for urea with pulsatile flow was higher in all experiments even when ultrafiltration was prevented. Clearance of aspartame and B-12 also increased with pulsatile flow. We propose three mechanisms by which pulsatile flow is more efficient than steady flow hemodialysis: greater fluid energy, avoidance of molecular channeling and avoidance of membrane layering. We hypothesize that using pulsatile flow in hemodialysis can significantly shorten the duration of dialysis sessions for most of the patients, and consequently reduce the duration of the procedure and its cost.
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Affiliation(s)
- T M Runge
- Department of Medicine and Surgery, University of Texas Health Science Center at San Antonio
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Rossetti L, Farrace S, Choi SB, Giaccari A, Sloan L, Frontoni S, Katz MS. Multiple metabolic effects of CGRP in conscious rats: role of glycogen synthase and phosphorylase. Am J Physiol 1993; 264:E1-10. [PMID: 8430777 DOI: 10.1152/ajpendo.1993.264.1.e1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Calcitonin gene-related peptide (CGRP) is a neuropeptide that is released at the neuromuscular junction in response to nerve excitation. To examine the relationship between plasma CGRP concentration and intracellular glucose metabolism in conscious rats, we performed insulin (22 pmol.kg-1.min-1) clamp studies combined with the infusion of 0, 20, 50, 100, 200, and 500 pmol.kg-1.min-1 CGRP (plasma concentrations ranging from 2 x 10(-11) to 5 x 10(-9) M). CGRP antagonized insulin's suppression of hepatic glucose production at plasma concentrations (approximately 10(-10) M) that are only two- to fivefold its basal portal concentration. Insulin-mediated glucose disposal was decreased by 20-32% when CGRP was infused at 50 pmol.kg-1.min-1 (plasma concentration 3 x 10(-10) M) or more. The impairment in insulin-stimulated glycogen synthesis in skeletal muscle accounted for all of the CGRP-induced decrease in glucose disposal, while whole body glycolysis was increased despite the reduction in total glucose uptake. The muscle glucose 6-phosphate concentration progressively increased during the CGRP infusions. CGRP inhibited insulin-stimulated glycogen synthase in skeletal muscle with a 50% effective dose of 1.9 +/- 0.36 x 10(-10) M. This effect on glycogen synthase was due to a reduction in enzyme affinity for UDP-glucose, with no changes in the maximal velocity. In vitro CGRP stimulated both hepatic and skeletal muscle adenylate cyclase in a dose-dependent manner. These data suggest that 1) CGRP is a potent antagonist of insulin at the level of muscle glycogen synthesis and hepatic glucose production; 2) inhibition of glycogen synthase is its major biochemical action in skeletal muscle; and 3) these effects are present at concentrations of the peptide that may be in the physiological range for portal vein and skeletal muscle. These data underscore the potential role of CGRP in the physiological modulation of intracellular glucose metabolism.
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Affiliation(s)
- L Rossetti
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461
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Coakley J, Hawkins R, Crinis N, McManus J, Blake D, Nordmann Y, Sloan L, Connelly J. An unusual case of variegate porphyria with possible homozygous inheritance. Aust N Z J Med 1990; 20:587-9. [PMID: 2222353 DOI: 10.1111/j.1445-5994.1990.tb01320.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report an unusual case of variegate porphyria in a young girl with epilepsy, mental retardation and premature adrenarche. Symptoms of porphyria commenced about the age of 12 years and death occurred about 18 months later. The patient had very low protoporphyrinogen oxidase activity in her cultured fibroblasts. Both parents had half the normal activity of this enzyme in lymphocytes and are heterozygous for the abnormal gene for variegate porphyria. Therefore, it is possible that the patient was a homozygous variant. Anticonvulsant therapy and low hepatic 5 alpha reductase activity were probably other contributing factors to the severity of the condition in this patient.
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Affiliation(s)
- J Coakley
- Department of Clinical Biochemistry, Royal Children's Hospital, Vic
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Swanson PD, Julien F, Emanuel MA, Sloan L, Tang T, Detemple TA, Coleman JJ. Low-loss semiconductor waveguide bends. Opt Lett 1988; 13:245-247. [PMID: 19742042 DOI: 10.1364/ol.13.000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
An experimental comparison is made between the losses of waveguide bends in disorder-delineated waveguides in semiconductor superlattices composed of GaAs and AlAs layers for simple abrupt bends and abrupt bends with an additional half-angle guiding wall proposed by Shiina et al. [Opt. Lett. 11, 736 (1986)]. For light above the band gap of bulk GaAs, the abrupt and Shiina bends were found to have to 3-dB loss angles of 3 and 7 deg, respectively. This improved performance suggests that the specific geometry of the bends is yet another degree of freedom in designing guiding structure for planar routing.
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Sloan L. Side by side: volunteers and paid staff. Hosp Trustee 1987; 11:7-8, 19. [PMID: 10284827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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