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Sexton D, Nguyen HQ, Juethner S, Luo H, Zhang Z, Jasper P, Zhu AZX. A quantitative systems pharmacology model of plasma kallikrein-kinin system dysregulation in hereditary angioedema. J Pharmacokinet Pharmacodyn 2024:10.1007/s10928-024-09919-6. [PMID: 38734778 DOI: 10.1007/s10928-024-09919-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/09/2024] [Indexed: 05/13/2024]
Abstract
Hereditary angioedema (HAE) due to C1-inhibitor deficiency is a rare, debilitating, genetic disorder characterized by recurrent, unpredictable, attacks of edema. The clinical symptoms of HAE arise from excess bradykinin generation due to dysregulation of the plasma kallikrein-kinin system (KKS). A quantitative systems pharmacology (QSP) model that mechanistically describes the KKS and its role in HAE pathophysiology was developed based on HAE attacks being triggered by autoactivation of factor XII (FXII) to activated FXII (FXIIa), resulting in kallikrein production from prekallikrein. A base pharmacodynamic model was constructed and parameterized from literature data and ex vivo assays measuring inhibition of kallikrein activity in plasma of HAE patients or healthy volunteers who received lanadelumab. HAE attacks were simulated using a virtual patient population, with attacks recorded when systemic bradykinin levels exceeded 20 pM. The model was validated by comparing the simulations to observations from lanadelumab and plasma-derived C1-inhibitor clinical trials. The model was then applied to analyze the impact of nonadherence to a daily oral preventive therapy; simulations showed a correlation between the number of missed doses per month and reduced drug effectiveness. The impact of reducing lanadelumab dosing frequency from 300 mg every 2 weeks (Q2W) to every 4 weeks (Q4W) was also examined and showed that while attack rates with Q4W dosing were substantially reduced, the extent of reduction was greater with Q2W dosing. Overall, the QSP model showed good agreement with clinical data and could be used for hypothesis testing and outcome predictions.
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Affiliation(s)
- Dan Sexton
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Hoa Q Nguyen
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Salomé Juethner
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | | | | | | | - Andy Z X Zhu
- Takeda Development Center Americas, Inc., Lexington, MA, USA.
- Preclinical and Translational Science Department, Takeda Pharmaceutical Company Limited, 35 Landsdowne Street, Cambridge, MA, 02139, USA.
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2
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Jasper P, Jochem WC, Lambert-Porter E, Naeem U, Utazi CE. Mapping the prevalence of severe acute malnutrition in Papua, Indonesia by using geostatistical models. BMC Nutr 2022; 8:13. [PMID: 35152906 PMCID: PMC8842923 DOI: 10.1186/s40795-022-00504-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Severe acute malnutrition (SAM) is the most life-threatening form of malnutrition, and in 2019, approximately 14.3 million children under the age of 5 were considered to have SAM. The prevalence of child malnutrition is recorded through large-scale household surveys run at multi-year intervals. However, these surveys are expensive, yield estimates with high levels of aggregation, are run over large time intervals, and may show gaps in area coverage. Geospatial modelling approaches could address some of these challenges by combining geo-located survey data with geospatial data to produce mapped estimates that predict malnutrition risk in both surveyed and non-surveyed areas. Methods A secondary analysis of cluster-level program evaluation data (n = 123 primary sampling units) was performed to map severe acute malnutrition (SAM) in Papuan children under 2 years (0–23 months) of age with a spatial resolution of 1 × 1 km in Papua, Indonesia. The approach used Bayesian geostatistical modelling techniques and publicly available geospatial data layers. Results In Papua, Indonesia, SAM was predicted in geostatistical models by using six geospatial covariates related primarily to conditions of remoteness and inaccessibility. The predicted 1-km spatial resolution maps of SAM showed substantial spatial variation across the province. By combining the predicted rates of SAM with estimates of the population under 2 years of age, the prevalence of SAM in late 2018 was estimated to be around 15,000 children (95% CI 10,209–26,252). Further tests of the predicted levels suggested that in most areas of Papua, more than 5% of Papuan children under 2 years of age had SAM, while three districts likely had more than 15% of children with SAM. Conclusions Eradication of hunger and malnutrition remains a key development goal, and more spatially detailed data can guide efficient intervention strategies. The application of additional household survey datasets in geostatistical models is one way to improve the monitoring and timely estimation of populations at risk of malnutrition. Importantly, geospatial mapping can yield insights for both surveyed and non-surveyed areas and can be applied in low-income country contexts where data is scarce and data collection is expensive or regions are inaccessible. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00504-z.
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Affiliation(s)
- Paul Jasper
- Oxford Policy Management Limited, Level 3, Clarendon House, 52 Cornmarket Street, Oxford, OX1 3HJ, UK
| | - Warren C Jochem
- School of Geography and Environmental Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Emma Lambert-Porter
- Oxford Policy Management Limited, Level 3, Clarendon House, 52 Cornmarket Street, Oxford, OX1 3HJ, UK.
| | - Umer Naeem
- Oxford Policy Management Limited, Level 3, Clarendon House, 52 Cornmarket Street, Oxford, OX1 3HJ, UK
| | - Chigozie Edson Utazi
- School of Geography and Environmental Sciences, University of Southampton, Southampton, SO17 1BJ, UK.,Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, SO17 1BJ, UK
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3
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Betts A, Clark T, Jasper P, Tolsma J, van der Graaf PH, Graziani EI, Rosfjord E, Sung M, Ma D, Barletta F. Use of translational modeling and simulation for quantitative comparison of PF-06804103, a new generation HER2 ADC, with Trastuzumab-DM1. J Pharmacokinet Pharmacodyn 2020; 47:513-526. [PMID: 32710210 PMCID: PMC7520420 DOI: 10.1007/s10928-020-09702-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/07/2020] [Indexed: 12/26/2022]
Abstract
A modeling and simulation approach was used for quantitative comparison of a new generation HER2 antibody drug conjugate (ADC, PF-06804103) with trastuzumab-DM1 (T-DM1). To compare preclinical efficacy, the pharmacokinetic (PK)/pharmacodynamic (PD) relationship of PF-06804103 and T-DM1 was determined across a range of mouse tumor xenograft models, using a tumor growth inhibition model. The tumor static concentration was assigned as the minimal efficacious concentration. PF-06804103 was concluded to be more potent than T-DM1 across cell lines studied. TSCs ranged from 1.0 to 9.8 µg/mL (n = 7) for PF-06804103 and from 4.7 to 29 µg/mL (n = 5) for T-DM1. Two experimental models which were resistant to T-DM1, responded to PF-06804103 treatment. A mechanism-based target mediated drug disposition (TMDD) model was used to predict the human PK of PF-06804103. This model was constructed and validated based on T-DM1 which has non-linear PK at doses administered in the clinic, driven by binding to shed HER2. Non-linear PK is predicted for PF-06804103 in the clinic and is dependent upon circulating HER2 extracellular domain (ECD) concentrations. The models were translated to human and suggested greater efficacy for PF-06804103 compared to T-DM1. In conclusion, a fit-for-purpose translational PK/PD strategy for ADCs is presented and used to compare a new generation HER2 ADC with T-DM1.
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Affiliation(s)
- Alison Betts
- Department of Biomedicine Design, Pfizer Inc, 610 Main Street, Cambridge, MA, 02139, USA.
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, 2300 RA, Leiden, The Netherlands.
- Applied Biomath, 561 Virginia Rd, Suite 220, Concord, MA, 01742, USA.
| | - Tracey Clark
- Worldwide Research Procurement, Pfizer Inc, Eastern Point Rd, Groton, CT, 06340, USA
| | - Paul Jasper
- RES Group, Inc, 75 Second Avenue, Needham, MA, 02494, USA
| | - John Tolsma
- RES Group, Inc, 75 Second Avenue, Needham, MA, 02494, USA
| | - Piet H van der Graaf
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, 2300 RA, Leiden, The Netherlands
| | | | - Edward Rosfjord
- Oncology Research & Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY, 10965, USA
| | - Matthew Sung
- Oncology Research & Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY, 10965, USA
| | - Dangshe Ma
- Department of Therapeutic Proteins, Regeneron, Tarrytown, NY, 10591, USA
| | - Frank Barletta
- Oncology Research & Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY, 10965, USA.
- Department of Biomedicine, Design Pfizer Inc, Design Pfizer Inc, Pearl River, NY, 10965, USA.
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4
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Jones HM, Tolsma J, Zhang Z, Jasper P, Luo H, Weber GL, Wright K, Bard J, Bell R, Messing D, Kelleher K, Piche-Nicholas N, Webster R. A Physiologically-Based Pharmacokinetic Model for the Prediction of "Half-Life Extension" and "Catch and Release" Monoclonal Antibody Pharmacokinetics. CPT Pharmacometrics Syst Pharmacol 2020; 9:534-541. [PMID: 32697437 PMCID: PMC7499188 DOI: 10.1002/psp4.12547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
Monoclonal antibodies (mAbs) can be engineered to have “extended half‐life” and “catch and release” properties to improve target coverage. We have developed a mAb physiologically‐based pharmacokinetic model that describes intracellular trafficking, neonatal Fc receptor (FcRn) recycling, and nonspecific clearance of mAbs. We extended this model to capture target binding as a function of target affinity, expression, and turnover. For mAbs engineered to have an extended half‐life, the model was able to accurately predict the terminal half‐life (82% within 2‐fold error of the observed value) in the human FcRn transgenic (Tg32) homozygous mouse and human. The model also accurately captures the trend in pharmacokinetic and target coverage data for a set of mAbs with differing catch and release properties in the Tg32 mouse. The mechanistic nature of this model allows us to explore different engineering techniques early in drug discovery, potentially expanding the number of “druggable” targets.
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Affiliation(s)
- Hannah M Jones
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | | | | | | | - Haobin Luo
- RES Group Inc., Needham, Massachusetts, USA
| | - Gregory L Weber
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - Katherine Wright
- BioMedicine Design, Pfizer Worldwide R&D, Andover, Massachusetts, USA
| | - Joel Bard
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - Robert Bell
- Rare Disease Research Unit, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - Dean Messing
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - Kerry Kelleher
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | | | - Robert Webster
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
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5
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Adegoke O, Arif S, Bahwere P, Harb J, Hug J, Jasper P, Mudzongo P, Nanama S, Olisenekwu G, Visram A. Incidence of severe acute malnutrition after treatment: A prospective matched cohort study in Sokoto, Nigeria. Matern Child Nutr 2020; 17:e13070. [PMID: 32761792 PMCID: PMC7729648 DOI: 10.1111/mcn.13070] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/22/2020] [Accepted: 07/16/2020] [Indexed: 01/06/2023]
Abstract
Severe acute malnutrition (SAM) among children in Nigeria is tackled through the outpatient therapeutic programme (OTP) of the Community-based Management of Acute Malnutrition (CMAM) programme. CMAM is evidently effective in resolving SAM, but little evidence exists on the remaining risk of SAM relapse for children discharged as cured from the OTP. We aimed to measure and compare the 6-month incidence of SAM among OTP-cured and community control children and identify factors associated with SAM relapse. We conducted a prospective matched cohort study that tracked 553 OTP-cured and 526 control children in Sokoto State, Northern Nigeria. Outcomes and covariates were measured fortnightly in up to 12 home visits. We used multivariate Cox and accelerated failure time models to identify significant risk correlates, where the covariates to be tested for correlation with relapse were selected using domain knowledge and automatic feature selection methods. SAM incidence rates were 52 times higher in the OTP-cured cohort (0.204/100 child-days) than in the community control cohort (0.004/100 child-days). Children with lower mid-upper arm circumference at OTP admission, with lower height/length-for-age z-scores, whose household head did not work over the full year, who lived in an area previously affected by environmental shocks, who were female and who had diarrhoea before the visit had a significantly higher relapse risk. Our study shows that OTP-cured children remain at a significantly excess risk of SAM. To improve long-term health outcomes of these children, programmes adopting a CMAM approach should strengthen follow-up care and be integrated with other preventive services.
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Affiliation(s)
| | | | - Paluku Bahwere
- Valid International, Oxford, UK.,Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Jana Harb
- Oxford Policy Management, Oxford, UK
| | - Julia Hug
- Oxford Policy Management, Oxford, UK
| | | | - Paul Mudzongo
- United Nations Children's Fund (UNICEF) Nigeria, Abuja, Nigeria
| | - Simeon Nanama
- United Nations Children's Fund (UNICEF) Nigeria, Abuja, Nigeria
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6
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Abrams R, Kaddi CD, Tao M, Leiser RJ, Simoni G, Reali F, Tolsma J, Jasper P, van Rijn Z, Li J, Niesner B, Barrett JS, Marchetti L, Peterschmitt MJ, Azer K, Neves-Zaph S. A Quantitative Systems Pharmacology Model of Gaucher Disease Type 1 Provides Mechanistic Insight Into the Response to Substrate Reduction Therapy With Eliglustat. CPT Pharmacometrics Syst Pharmacol 2020; 9:374-383. [PMID: 32558397 PMCID: PMC7376290 DOI: 10.1002/psp4.12506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 12/27/2022]
Abstract
Gaucher’s disease type 1 (GD1) leads to significant morbidity and mortality through clinical manifestations, such as splenomegaly, hematological complications, and bone disease. Two types of therapies are currently approved for GD1: enzyme replacement therapy (ERT), and substrate reduction therapy (SRT). In this study, we have developed a quantitative systems pharmacology (QSP) model, which recapitulates the effects of eliglustat, the only first‐line SRT approved for GD1, on treatment‐naïve or patients with ERT‐stabilized adult GD1. This multiscale model represents the mechanism of action of eliglustat that leads toward reduction of spleen volume. Model capabilities were illustrated through the application of the model to predict ERT and eliglustat responses in virtual populations of adult patients with GD1, representing patients across a spectrum of disease severity as defined by genotype‐phenotype relationships. In summary, the QSP model provides a mechanistic computational platform for predicting treatment response via different modalities within the heterogeneous GD1 patient population.
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Affiliation(s)
- Ruth Abrams
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Chanchala D Kaddi
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Mengdi Tao
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Randolph J Leiser
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Giulia Simoni
- Fondazione The Microsoft Research - University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto, Italy
| | - Federico Reali
- Fondazione The Microsoft Research - University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto, Italy
| | | | | | - Zachary van Rijn
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Jing Li
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Bradley Niesner
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Jeffrey S Barrett
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Luca Marchetti
- Fondazione The Microsoft Research - University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto, Italy
| | | | - Karim Azer
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
| | - Susana Neves-Zaph
- Translational Disease Modelling, Digital Data Science, Sanofi, Bridgewater, New Jersey, USA
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7
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Nguyen HQ, Iskenderian A, Ehmann D, Jasper P, Zhang Z, Rong H, Welty D, Narayanan R. Leveraging Quantitative Systems Pharmacology Approach into Development of Human Recombinant Follistatin Fusion Protein for Duchenne Muscular Dystrophy. CPT Pharmacometrics Syst Pharmacol 2020; 9:342-352. [PMID: 32419339 PMCID: PMC7306616 DOI: 10.1002/psp4.12518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
Quantitative understanding about the dynamics of drug-target interactions in biological systems is essential, especially in rare disease programs with small patient populations. Follistatin, by antagonism of myostatin and activin, which are negative regulators of skeletal muscle and inflammatory response, is a promising therapeutic target for Duchenne Muscular Dystrophy. In this study, we constructed a quantitative systems pharmacology model for FS-EEE-Fc, a follistatin recombinant protein to investigate its efficacy from dual target binding, and, subsequently, to project its human efficacious dose. Based on model simulations, with an assumed efficacy threshold of 7-10% muscle volume increase, 3-5 mg/kg weekly dosing of FS-EEE-Fc is predicted to achieve meaningful clinical outcome. In conclusion, the study demonstrated an application of mechanism driven approach at early stage of a rare disease drug development to support lead compound optimization, enable human dose, pharmacokinetics, and efficacy predictions.
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Affiliation(s)
- Hoa Q Nguyen
- Shire HGT, Inc. (a Takeda company), Lexington, Massachusetts, USA
| | | | - David Ehmann
- Shire HGT, Inc. (a Takeda company), Lexington, Massachusetts, USA
| | - Paul Jasper
- RES Group, Inc., Needham, Massachusetts, USA
| | | | - Haojing Rong
- Kymera Therapeutics, Cambridge, Massachusetts, USA
| | - Devin Welty
- Nuventra Pharma Sciences, Research Triangle Park, North Carolina, USA
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8
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Jones HM, Zhang Z, Jasper P, Luo H, Avery LB, King LE, Neubert H, Barton HA, Betts AM, Webster R. A Physiologically-Based Pharmacokinetic Model for the Prediction of Monoclonal Antibody Pharmacokinetics From In Vitro Data. CPT Pharmacometrics Syst Pharmacol 2019; 8:738-747. [PMID: 31464379 PMCID: PMC6813168 DOI: 10.1002/psp4.12461] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/14/2019] [Indexed: 11/07/2022]
Abstract
Monoclonal antibody (mAb) pharmacokinetics (PK) have largely been predicted via allometric scaling with little consideration for cross-species differences in neonatal Fc receptor (FcRn) affinity or clearance/distribution mechanisms. To address this, we developed a mAb physiologically-based PK model that describes the intracellular trafficking and FcRn recycling of mAbs in a human FcRn transgenic homozygous mouse and human. This model uses mAb-specific in vitro data together with species-specific FcRn tissue expression, tissue volume, and blood-flow physiology to predict mAb in vivo linear PK a priori. The model accurately predicts the terminal half-life of 90% of the mAbs investigated within a twofold error. The mechanistic nature of this model allows us to not only predict linear PK from in vitro data but also explore the PK and target binding of mAbs engineered to have pH-dependent binding to its target or FcRn and could aid in the selection of mAbs with optimal PK and pharmacodynamic properties.
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Affiliation(s)
- Hannah M Jones
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | | | | | - Haobin Luo
- RES Group Inc, Needham, Massachusetts, USA
| | | | - Lindsay E King
- BioMedicine Design, Pfizer Worldwide R&D, Andover, Massachusetts, USA
| | - Hendrik Neubert
- BioMedicine Design, Pfizer Worldwide R&D, Andover, Massachusetts, USA
| | - Hugh A Barton
- BioMedicine Design, Pfizer Worldwide R&D, Groton, Connecticut, USA
| | - Alison M Betts
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - Robert Webster
- BioMedicine Design, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
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9
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Kaddi CD, Niesner B, Baek R, Jasper P, Pappas J, Tolsma J, Li J, van Rijn Z, Tao M, Ortemann‐Renon C, Easton R, Tan S, Puga AC, Schuchman EH, Barrett JS, Azer K. Quantitative Systems Pharmacology Modeling of Acid Sphingomyelinase Deficiency and the Enzyme Replacement Therapy Olipudase Alfa Is an Innovative Tool for Linking Pathophysiology and Pharmacology. CPT Pharmacometrics Syst Pharmacol 2018; 7:442-452. [PMID: 29920993 PMCID: PMC6063739 DOI: 10.1002/psp4.12304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022] Open
Abstract
Acid sphingomyelinase deficiency (ASMD) is a rare lysosomal storage disorder with heterogeneous clinical manifestations, including hepatosplenomegaly and infiltrative pulmonary disease, and is associated with significant morbidity and mortality. Olipudase alfa (recombinant human acid sphingomyelinase) is an enzyme replacement therapy under development for the non-neurological manifestations of ASMD. We present a quantitative systems pharmacology (QSP) model supporting the clinical development of olipudase alfa. The model is multiscale and mechanistic, linking the enzymatic deficiency driving the disease to molecular-level, cellular-level, and organ-level effects. Model development was informed by natural history, and preclinical and clinical studies. By considering patient-specific pharmacokinetic (PK) profiles and indicators of disease severity, the model describes pharmacodynamic (PD) and clinical end points for individual patients. The ASMD QSP model provides a platform for quantitatively assessing systemic pharmacological effects in adult and pediatric patients, and explaining variability within and across these patient populations, thereby supporting the extrapolation of treatment response from adults to pediatrics.
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Affiliation(s)
| | - Bradley Niesner
- Translational Informatics, TMED, Sanofi, BridgewaterNew JerseyUSA
| | - Rena Baek
- Sanofi Genzyme, CambridgeMassachusettsUSA
| | | | | | | | - Jing Li
- Translational Informatics, TMED, Sanofi, BridgewaterNew JerseyUSA
| | - Zachary van Rijn
- Translational Informatics, TMED, Sanofi, BridgewaterNew JerseyUSA
| | - Mengdi Tao
- Translational Informatics, TMED, Sanofi, BridgewaterNew JerseyUSA
| | | | - Rachael Easton
- Translational Informatics, TMED, Sanofi, BridgewaterNew JerseyUSA
| | - Sharon Tan
- Sanofi Genzyme, CambridgeMassachusettsUSA
| | | | - Edward H. Schuchman
- Genetics & Genomic Sciences, Icahn School of Medicine at Mount SinaiNew YorkNYUSA
| | | | - Karim Azer
- Translational Informatics, TMED, Sanofi, BridgewaterNew JerseyUSA
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10
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Shankaran H, Cronin A, Barnes J, Sharma P, Tolsma J, Jasper P, Mettetal JT. Systems Pharmacology Model of Gastrointestinal Damage Predicts Species Differences and Optimizes Clinical Dosing Schedules. CPT Pharmacometrics Syst Pharmacol 2017; 7:26-33. [PMID: 28941225 PMCID: PMC5784737 DOI: 10.1002/psp4.12255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/08/2017] [Accepted: 09/18/2017] [Indexed: 12/14/2022]
Abstract
Gastrointestinal (GI) adverse events (AEs) are frequently dose limiting for oncology agents, requiring extensive clinical testing of alternative schedules to identify optimal dosing regimens. Here, we develop a translational mathematical model to predict these clinical AEs starting from preclinical GI toxicity data. The model structure incorporates known biology and includes stem cells, daughter cells, and enterocytes. Published data, including cellular numbers and division times, informed the system parameters for humans and rats. The drug‐specific parameters were informed with preclinical histopathology data from rats treated with irinotecan. The model fit the rodent irinotecan‐induced pathology changes well. The predicted time course of enterocyte loss in patients treated with weekly doses matched observed AE profiles. The model also correctly predicts a lower level of AEs for every 3 weeks (Q3W), as compared to the weekly schedule.
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Affiliation(s)
- Harish Shankaran
- Drug Safety and MetabolismIMED Biotech Unit, AstraZenecaWalthamMassachusettsUSA
| | - Anna Cronin
- Drug Safety and MetabolismIMED Biotech UnityAstraZenecaCambridgeUK
| | - Jen Barnes
- Drug Safety and MetabolismIMED Biotech UnityAstraZenecaCambridgeUK
| | - Pradeep Sharma
- Drug Safety and MetabolismIMED Biotech UnityAstraZenecaCambridgeUK
| | | | | | - Jerome T. Mettetal
- Drug Safety and MetabolismIMED Biotech Unit, AstraZenecaWalthamMassachusettsUSA
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11
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Tiwari A, Luo H, Chen X, Singh P, Bhattacharya I, Jasper P, Tolsma JE, Jones HM, Zutshi A, Abraham AK. Assessing the Impact of Tissue Target Concentration Data on Uncertainty in In Vivo Target Coverage Predictions. CPT Pharmacometrics Syst Pharmacol 2016; 5:565-574. [PMID: 27770597 PMCID: PMC5080652 DOI: 10.1002/psp4.12126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/19/2016] [Indexed: 01/18/2023]
Abstract
Understanding pharmacological target coverage is fundamental in drug discovery and development as it helps establish a sequence of research activities, from laboratory objectives to clinical doses. To this end, we evaluated the impact of tissue target concentration data on the level of confidence in tissue coverage predictions using a site of action (SoA) model for antibodies. By fitting the model to increasing amounts of synthetic tissue data and comparing the uncertainty in SoA coverage predictions, we confirmed that, in general, uncertainty decreases with longitudinal tissue data. Furthermore, a global sensitivity analysis showed that coverage is sensitive to experimentally identifiable parameters, such as baseline target concentration in plasma and target turnover half‐life and fixing them reduces uncertainty in coverage predictions. Overall, our computational analysis indicates that measurement of baseline tissue target concentration reduces the uncertainty in coverage predictions and identifies target‐related parameters that greatly impact the confidence in coverage predictions.
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Affiliation(s)
- A Tiwari
- Department of Pharmacokinetics, Dynamics, and Metabolism, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA.
| | - H Luo
- RES Group, Needham, Massachusetts, USA
| | - X Chen
- Department of Pharmacokinetics, Dynamics, and Metabolism, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - P Singh
- Department of Pharmacokinetics, Dynamics, and Metabolism, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - I Bhattacharya
- Quantitative Clinical Sciences, PharmaTherapeutics R&D, Pfizer Inc., Cambridge, Massachusetts, USA
| | - P Jasper
- RES Group, Needham, Massachusetts, USA
| | | | - H M Jones
- Department of Pharmacokinetics, Dynamics, and Metabolism, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
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Betts AM, Haddish-Berhane N, Tolsma J, Jasper P, King LE, Sun Y, Chakrapani S, Shor B, Boni J, Johnson TR. Preclinical to Clinical Translation of Antibody-Drug Conjugates Using PK/PD Modeling: a Retrospective Analysis of Inotuzumab Ozogamicin. AAPS J 2016; 18:1101-1116. [PMID: 27198897 DOI: 10.1208/s12248-016-9929-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/05/2016] [Indexed: 01/08/2023]
Abstract
A mechanism-based pharmacokinetic/pharmacodynamic (PK/PD) model was used for preclinical to clinical translation of inotuzumab ozogamicin, a CD22-targeting antibody-drug conjugate (ADC) for B cell malignancies including non-Hodgkin's lymphoma (NHL) and acute lymphocytic leukemia (ALL). Preclinical data was integrated in a PK/PD model which included (1) a plasma PK model characterizing disposition and clearance of inotuzumab ozogamicin and its released payload N-Ac-γ-calicheamicin DMH, (2) a tumor disposition model describing ADC diffusion into the tumor extracellular environment, (3) a cellular model describing inotuzumab ozogamicin binding to CD22, internalization, intracellular N-Ac-γ-calicheamicin DMH release, binding to DNA, or efflux from the tumor cell, and (4) tumor growth and inhibition in mouse xenograft models. The preclinical model was translated to the clinic by incorporating human PK for inotuzumab ozogamicin and clinically relevant tumor volumes, tumor growth rates, and values for CD22 expression in the relevant patient populations. The resulting stochastic models predicted progression-free survival (PFS) rates for inotuzumab ozogamicin in patients comparable to the observed clinical results. The model suggested that a fractionated dosing regimen is superior to a conventional dosing regimen for ALL but not for NHL. Simulations indicated that tumor growth is a highly sensitive parameter and predictive of successful outcome. Inotuzumab ozogamicin PK and N-Ac-γ-calicheamicin DMH efflux are also sensitive parameters and would be considered more useful predictors of outcome than CD22 receptor expression. In summary, a multiscale, mechanism-based model has been developed for inotuzumab ozogamicin, which can integrate preclinical biomeasures and PK/PD data to predict clinical response.
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Affiliation(s)
- Alison M Betts
- Department of Pharmacokinetics Dynamics and Metabolism, Pfizer Global Research and Development, Groton, Connecticut, 06340, USA. .,Department of Pharmacokinetics Dynamics and Metabolism - NBE, Pfizer Global Research and Development, Eastern Point Road, Groton, Connecticut, 06340, USA.
| | - Nahor Haddish-Berhane
- Clinical Pharmacology and Pharmacometrics, Quantitative Sciences, Janssen Pharmaceuticals, Spring House, Pennsylvania, 19002, USA
| | - John Tolsma
- RES Group, Inc., 75 Second Avenue, Needham, Massachusetts, 02494, USA
| | - Paul Jasper
- RES Group, Inc., 75 Second Avenue, Needham, Massachusetts, 02494, USA
| | - Lindsay E King
- Department of Pharmacokinetics Dynamics and Metabolism, Pfizer Global Research and Development, Groton, Connecticut, 06340, USA
| | - Yongliang Sun
- Clinical Translational Technologies & Operations, Bristol-Myers Squibb Co., Pennington, New Jersey, 08534, USA
| | - Subramanyam Chakrapani
- Department of World Wide Medicinal Chemistry, Pfizer Global Research and Development, Groton, Connecticut, 06340, USA
| | - Boris Shor
- Immune Pharmaceuticals Inc., 430 East 29th Street, Suite 940, New York, New York, 10016, USA
| | - Joseph Boni
- Department of Clinical Pharmacology, Pfizer Global Research and Development, Collegeville, Pennsylvania, USA
| | - Theodore R Johnson
- Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Global Research and Development, La Jolla, California, USA
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Checkley S, MacCallum L, Yates J, Jasper P, Luo H, Tolsma J, Bendtsen C. Erratum: Corrigendum: Bridging the gap between in vitro and in vivo: Dose and schedule predictions for the ATR inhibitor AZD6738. Sci Rep 2016; 6:16545. [PMID: 26859465 PMCID: PMC4747154 DOI: 10.1038/srep16545] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chien HC, Zur AA, Maurer TS, Yee SW, Tolsma J, Jasper P, Scott DO, Giacomini KM. Rapid Method To Determine Intracellular Drug Concentrations in Cellular Uptake Assays: Application to Metformin in Organic Cation Transporter 1-Transfected Human Embryonic Kidney 293 Cells. ACTA ACUST UNITED AC 2015; 44:356-64. [PMID: 26700958 DOI: 10.1124/dmd.115.066647] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/22/2015] [Indexed: 11/22/2022]
Abstract
Because of the importance of intracellular unbound drug concentrations in the prediction of in vivo concentrations that are determinants of drug efficacy and toxicity, a number of assays have been developed to assess in vitro unbound concentrations of drugs. Here we present a rapid method to determine the intracellular unbound drug concentrations in cultured cells, and we apply the method along with a mechanistic model to predict concentrations of metformin in subcellular compartments of stably transfected human embryonic kidney 293 (HEK293) cells. Intracellular space (ICS) was calculated by subtracting the [(3)H]-inulin distribution volume (extracellular space, ECS) from the [(14)C]-urea distribution volume (total water space, TWS). Values obtained for intracellular space (mean ± S.E.M.; μl/10(6) cells) of monolayers of HEK cells (HEK-empty vector [EV]) and cells overexpressing human organic cation transporter 1 (HEK-OCT1), 1.21± 0.07 and 1.25±0.06, respectively, were used to determine the intracellular metformin concentrations. After incubation of the cells with 5 µM metformin, the intracellular concentrations were 26.4 ± 7.8 μM and 268 ± 11.0 μM, respectively, in HEK-EV and HEK-OCT1. In addition, intracellular metformin concentrations were lower in high K(+) buffer (140 mM KCl) compared with normal K(+) buffer (5.4 mM KCl) in HEK-OCT1 cells (54.8 ± 3.8 μM and 198.1 ± 11.2 μM, respectively; P < 0.05). Our mechanistic model suggests that, depending on the credible range of assumed physiologic values, the positively charged metformin accumulates to particularly high levels in endoplasmic reticulum and/or mitochondria. This method together with the computational model can be used to determine intracellular unbound concentrations and to predict subcellular accumulation of drugs in other complex systems such as primary cells.
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Affiliation(s)
- Huan-Chieh Chien
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - Arik A Zur
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - Tristan S Maurer
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - Sook Wah Yee
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - John Tolsma
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - Paul Jasper
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - Dennis O Scott
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, Schools of Pharmacy and Medicine, University of California San Francisco, San Francisco, California (H.C.C., A.A.Z., S.W.Y., K.M.G.); Systems Modeling and Simulation (T.S.M.) and Cardiovascular and Metabolic Disease Research Unit (D.O.S.), Department of Pharmacokinetics, Dynamics and Metabolism, Pfizer Worldwide Research and Development, Cambridge, Massachusetts; RES Group, Inc. (J.T., P.J.) Needham, Massachusetts
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Checkley S, MacCallum L, Yates J, Jasper P, Luo H, Tolsma J, Bendtsen C. Bridging the gap between in vitro and in vivo: Dose and schedule predictions for the ATR inhibitor AZD6738. Sci Rep 2015; 5:13545. [PMID: 26310312 PMCID: PMC4550834 DOI: 10.1038/srep13545] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 04/14/2015] [Accepted: 07/30/2015] [Indexed: 12/28/2022] Open
Abstract
Understanding the therapeutic effect of drug dose and scheduling is critical to inform the design and implementation of clinical trials. The increasing complexity of both mono, and particularly combination therapies presents a substantial challenge in the clinical stages of drug development for oncology. Using a systems pharmacology approach, we have extended an existing PK-PD model of tumor growth with a mechanistic model of the cell cycle, enabling simulation of mono and combination treatment with the ATR inhibitor AZD6738 and ionizing radiation. Using AZD6738, we have developed multi-parametric cell based assays measuring DNA damage and cell cycle transition, providing quantitative data suitable for model calibration. Our in vitro calibrated cell cycle model is predictive of tumor growth observed in in vivo mouse xenograft studies. The model is being used for phase I clinical trial designs for AZD6738, with the aim of improving patient care through quantitative dose and scheduling prediction.
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Affiliation(s)
| | | | - James Yates
- AstraZeneca, Alderley Park, Macclesfield, SK10 4TG. UK
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Mathai E, Rolain JM, Verghese L, Mathai M, Jasper P, Verghese G, Raoult D. Case reports: scrub typhus during pregnancy in India. Trans R Soc Trop Med Hyg 2004; 97:570-2. [PMID: 15307429 DOI: 10.1016/s0035-9203(03)80032-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Scrub typhus, caused by Orientia tsutsugamushi, is a rural zoonosis endemic in the Asian Pacific region. Doxycycline and chloramphenicol, the recommended drugs for treating this infection, may not be safe during pregnancy. We report on 5 patients with scrub typhus during pregnancy who were seen in India between October 2001 and February 2002. Four of the 5 women were treated initially with ciprofloxacin. Three women had stillbirths, 1 an abortion and 1 a low birthweight baby, which suggests that ciprofloxacin should not be used for treating pregnant women and that scrub typhus leads to severe adverse effects during pregnancy. Randomized controlled trials are urgently needed to ascertain the optimal drug choice, given that currently recommended drugs are contraindicated in pregnant women.
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Affiliation(s)
- E Mathai
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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17
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Lanning D, Jasper P, Knight K. Seminars in Immunology comments 3. Semin Immunol 2002. [DOI: 10.1016/s1044-5323(02)00051-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Dennis Lanning
- Department of Microbiology and Immunology, Loyola University of Chicago, Maywood, IL 60153, USA
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Muth ER, Laurent JM, Jasper P. The effect of bilberry nutritional supplementation on night visual acuity and contrast sensitivity. Altern Med Rev 2000; 5:164-73. [PMID: 10767671] [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: 02/16/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effect of bilberry on night visual acuity (VA) and night contrast sensitivity (CS). METHODS This study utilized a double-blind, placebo-controlled, crossover design. The subjects were young males with good vision; eight received placebo and seven received active capsules for three weeks. Active capsules contained 160 mg of bilberry extract (25-percent anthocyanosides), and the placebo capsules contained only inactive ingredients. Subjects ingested one active or placebo capsule three times daily for 21 days. After the three-week treatment period, a one-month washout period was employed to allow any effect of bilberry on night vision to dissipate. In the second three-week treatment period, the eight subjects who first received placebo were given active capsules, and the seven who first received active capsules were given placebo. Night VA and night CS was tested throughout the three-month experiment. RESULTS There was no difference in night VA during any of the measurement periods when examining the average night VA or the last night VA measurement during active and placebo treatments. In addition, there was no difference in night CS during any of the measurement periods when examining the average night CS or the last night CS measurement during active and placebo treatments. CONCLUSION The current study failed to find an effect of bilberry on night VA or night CS for a high dose of bilberry taken for a significant duration. Hence, the current study casts doubt on the proposition that bilberry supplementation, in the forms currently available and in the doses recommended, is an effective treatment for the improvement of night vision in this population.
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Affiliation(s)
- E R Muth
- Naval Aerospace Medical Research Laboratory, NAS Pensacola, Florida 32508, USA
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Regi A, Jasper P, Mathai M, Peedicayil A. Analysis of perinatal deaths (1991-1999) in a tertiary care hospital in South India. Int J Gynaecol Obstet 2000. [DOI: 10.1016/s0020-7292(00)82699-5] [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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21
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Mathai E, Muthaiah A, Mathai M, Jasper P. Prevalence and effects of trichomoniasis in pregnancy. Natl Med J India 1998; 11:151. [PMID: 9707712] [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: 02/08/2023]
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22
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Peedicayil A, Jasper P, Francis S, Jayakrishnan K, Mathai M, Regi A. A randomized trial of extra-amniotic foley catheter and intra-cervical prostaglandin E2 for cervical ripening. J Clin Epidemiol 1998. [DOI: 10.1016/s0895-4356(98)90065-8] [Citation(s) in RCA: 2] [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: 10/26/2022]
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23
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Regi A, Mathai M, Jasper P, Krishnaswami H, Prem S, Peedicayil A. Ovarian hyperstimulation syndrome (OHSS) in pregnancy not associated with ovulation induction. Acta Obstet Gynecol Scand 1996; 75:599-600. [PMID: 8693942 DOI: 10.3109/00016349609054680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A Regi
- Department of Obstetrics and Gynecology, Christian Medical College Hospital, Vellore, India
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Mathai M, Thomas S, Jasper P. Amniotic fluid index in South Indian pregnancies. Int J Gynaecol Obstet 1996; 52:287-8. [PMID: 8775688 DOI: 10.1016/0020-7292(95)02618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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25
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Mathai M, Vijaykumar S, Joseph R, Karthikeyan NG, Regi A, Peedicayil A, Jasper P. The normal preterm foetal heart rate pattern. Indian J Med Res 1995; 101:108-10. [PMID: 7751037] [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: 01/26/2023] Open
Abstract
A longitudinal study was carried out on 38 women with low risk pregnancies. These women had cardiotocography at 27-28 wk initially, at fortnightly intervals thereafter until 36 wk and at weekly intervals thereafter until delivery. All cardiotocographs were analyzed by one investigator who was not aware of the individual clinical situation. Of the 232 cardiotocographs, 12 (0.5%) of poor quality were excluded from analyses. The mean base-line heart rate decreased from 142.5 (SD 6.03) beats per min at 27-30 wk to 138.2 (SD 7.4) at term. Analysis of variance for repeated measures showed that the decrease in foetal heart rate with gestation was statistically significant (P < 0.001). The number of accelerations increased with gestation (P = 0.002). There were no significant changes in variability and decelerations with increasing gestation.
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Affiliation(s)
- M Mathai
- Department of Obstetrics & Gynaecology, Christian Medical College Hospital, Vellore
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Abstract
OBJECTIVES To determine the pattern of intrauterine growth and the gestation at birth of Indian fetuses. METHOD One hundred twenty consecutive women who had reliable menstrual histories, low-risk pregnancies and who were booked for delivery at the Christian Medical College Hospital, Vellore, before 20 weeks' gestation were recruited to the study. Ultrasound fetal biometry was carried out at 4-weekly intervals from 20 weeks and at weekly intervals after 36 weeks until delivery. RESULTS Growth patterns of fetal biparietal diameter and femur length were comparable to those reported in Western populations. However there was a lag in growth of abdominal circumference (AC) after 28 weeks in comparison with that reported in Western populations. The median gestation at delivery following spontaneous labor was 39 weeks. No association was observed between rate of growth of AC and gestation at birth. CONCLUSION Slowing of growth of the fetal AC after 28 weeks and a shorter length of gestation result in the birth of smaller babies in this ethnic group. The implications of these findings are discussed.
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Affiliation(s)
- M Mathai
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, India
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Peedicayil A, Mathai M, Regi A, Aseelan L, Rekha K, Jasper P. Inter- and intra-observer variation in the amniotic fluid index. Obstet Gynecol 1994; 84:848-51. [PMID: 7936525] [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: 01/27/2023]
Abstract
OBJECTIVE To measure inter- and intra-observer reliability in the amniotic fluid index (AFI). METHODS To measure inter-observer reliability, three observers measured the AFI at random in 32 patients without knowing each other's results. To determine intra-observer reliability, each investigator made repeated measurements on ten other patients. Patients at 26-41 weeks' gestation who were referred for an antenatal ultrasound examination were asked to participate. Intra-observer reliability and inter-observer reliability were expressed as intra-class correlation coefficients. Inter-observer agreement was also expressed as the kappa statistic after dichotomizing the AFI (less than 8 cm, 8 cm or more). RESULTS The intra-class correlation coefficient for intra-observer reliability exceeded 0.8, and for inter-observer reliability it was 0.67 (95% confidence interval [CI] 0.52-0.79), with an overall kappa of 0.44 (95% CI 0.22-0.65). The percentage disagreement between pairs of observers reached 22-28%. CONCLUSION Measurements of AFI have good intra-observer and moderate inter-observer agreement. In clinical use, an AFI level near a cutoff value should be interpreted with caution.
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Affiliation(s)
- A Peedicayil
- Department of Obstetrics and Gynaecology, C.M.C. Hospital, Vellore, India
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Peedicayil A, Regi A, Mathai M, Jasper P. Colposcopy in women with a normal Papanicolaou smear. Natl Med J India 1994; 7:208-9. [PMID: 7827598] [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: 01/27/2023]
Abstract
BACKGROUND Colposcopy is usually done when the Papanicolaou smear is abnormal so that the necessity for cone biopsy is reduced. However, there is often a strong clinical suspicion of cervical neoplasia even though the smear is normal and this problem of the false negative Papanicolaou smear has not, we feel, been adequately addressed. We, therefore, examined the usefulness of colposcopy in detecting cervical neoplasia in women in whom the Papanicolaou smear was normal. METHODS A cross-sectional design was used which included 80 patients in whom cervical neoplasia was suspected and who had undergone colposcopy in one gynaecology unit at the Christian Medical College Hospital, Vellore. The Papanicolaou smear result of these patients was then related to their diagnosis on colposcopy. RESULTS The Papanicolaou smears were normal in 56 patients and abnormal in 24. In the normal Papanicolaou smear group there were 18 women with grade I cervical intra-epithelial neoplasia and 3 with grade II lesions. In the abnormal smear group there were 8 women with grade I cervical intra-epithelial neoplasia, 9 with grade II cervical intra-epithelial neoplasia and 1 had microinvasive carcinoma. Patients with abnormal Papanicolaou smears had a relative risk of 7.8 (95% CI 2.4 to 25.8) of having a lesion more advanced than grade I cervical intra-epithelial neoplasia compared with those in whom cervical neoplasia was only suspected clinically. CONCLUSION When the clinician suspects cervical neoplasia but the Papanicolaou smear is negative, colposcopy reveals at least grade II cervical intra-epithelial neoplasia in 5% of patients. Such patients, therefore, need to be followed up closely or else have a colposcopy and directed biopsy.
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Affiliation(s)
- A Peedicayil
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
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John TJ, Bhushan N, Babu PG, Seshadri L, Balasubramanium N, Jasper P. Prevalence of HIV infection in pregnant women in Vellore region. Indian J Med Res 1993; 97:227-30. [PMID: 8144202] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
All pregnant women attending the antenatal clinic of a large hospital in Vellore, India (Christian Medical College Hospital) were screened for HIV infection between October 1987 and June 1992. A total of 36,953 blood samples were thus screened and 20 infected women were identified. Among these 18 women had acquired HIV infection from their husbands, who were also detected to be HIV infected. While these 18 women were monogamous, all the husbands had multiple sex partners. Two of the 20 women in this series were commercial sex workers. Among the 20, 17 (85%) women belonged to low socio-economic status, while three were from well-to-do families, with the husbands being businessmen or teachers. As the overall prevalence (0.054%) of HIV infection among pregnant women was relatively high and equal to or higher than many States in the USA and in areas outside London in the UK, the authors recommend that strict universal precautions be instituted in all obstetric practice in India.
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Affiliation(s)
- T J John
- Department of Microbiology, National AIDS Reference & Surveillance Centre, Vellore
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Alexander R, Mathai E, Nayyar V, Mathew M, Jasper P. Low prevalence of chlamydial endocervical infection in antenatal south Indian women. Genitourin Med 1993; 69:240-1. [PMID: 8335319 PMCID: PMC1195069 DOI: 10.1136/sti.69.3.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
A randomized controlled study of valethamate bromide administered by intramuscular injection in acceleration of labor was done in 60 consecutive primigravidae and 60 consecutive multigravidae admitted in labor at 2-4 cm cervical dilatation. There was no difference observed in the rate of cervical dilatation between those who received valethamate bromide and those who received normal saline. However, maternal tachycardia was observed in significantly more women primigravida RR 1.97, 95% CI 1.3-3.0; multigravida RR 2.16, 95% CI 1.3-3.6) who had received valethamate bromide.
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Affiliation(s)
- S Kuruvila
- Department of Obstetrics and Gynecology, Christian Medical College Hospital, Vellore, India
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Sharp FR, Jasper P, Hall J, Noble L, Sagar SM. MK-801 and ketamine induce heat shock protein HSP72 in injured neurons in posterior cingulate and retrosplenial cortex. Ann Neurol 1991; 30:801-9. [PMID: 1838680 DOI: 10.1002/ana.410300609] [Citation(s) in RCA: 208] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
MK-801 and ketamine are noncompetitive N-methyl-D-aspartate (NMDA) receptor blockers that decrease brain injury in animal models of focal and global ischemia. Recent reports, however, suggested that MK-801 itself can damage neurons. Here we show that MK-801 (0.1 to 5.0 mg/kg) and ketamine (40 to 100 mg/kg) typically induce heat shock protein HSP72 mainly in layer 3 neurons of the posterior cingulate and retrosplenial cortex of the rat. These HSP72-immunoreactive neurons contain abnormal cytoplasmic vacuoles visualized by electron microscopy. The HSP72 immunoreactivity is maximal at 24 hours with 1.0-mg/kg doses of MK-801 and disappears by 2 weeks. Based on these data, we propose: (1) MK-801 and ketamine injure selected neurons, which express HSP72 in response to that injury. (2) Since HSP72 is induced for 1 to 2 weeks, the prolonged psychological side effects of MK-801, ketamine, phencyclidine, and related drugs could be related to this injury. (3) The neuroprotective effect of MK-801 is probably not related to HSP72 induction. (4) HSP72 immunocytochemistry is useful for studying nonlethal neuronal injury from a wide variety of brain insults.
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Affiliation(s)
- F R Sharp
- Department of Neurology, University of California, San Francisco
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Affiliation(s)
- U Menon
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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Sharp JW, Sagar SM, Hisanaga K, Jasper P, Sharp FR. The NMDA receptor mediates cortical induction of fos and fos-related antigens following cortical injury. Exp Neurol 1990; 109:323-32. [PMID: 1698651 DOI: 10.1016/s0014-4886(05)80023-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cortical cavity lesions and lateral ventricular injections of quinolinic acid, a NMDA receptor agonist, induce Fos and Fos-related antigens (FRAs) throughout ipsilateral adult rat brain cortex in similar patterns. c-fos mRNA, assessed using in situ hybridization, was induced by 1 h and disappeared between 3 and 8 h following cortical lesions. Fos proteins, detected using a specific monoclonal antibody, were induced by 1 h and disappeared by 4 h after cortical lesions. FRA proteins, detected using polyclonal antibodies, were induced between 1 and 4 h and persisted for at least 72 h following focal cortical injury. Intraventricular injections of CPP, a competitive NMDA receptor antagonist, completely blocked the induction of these nuclear proteins in cortex ipsilateral to the focal cortical lesions--except around the injury site itself. Intraventricular injections of quisqualate, a non-NMDA glutamate analogue, induced Fos in hippocampus but not in cortex. These data show that NMDA receptors mediate the induction of Fos and FRAs following cortical injury. It is proposed that local cortical injury releases excitatory amino acids that act at NMDA receptors to initiate spreading depression and that the resultant depolarization induces Fos in neurons throughout the cortex. Since Fos and FRAs are proteins that regulate the expression of target genes, they could mediate long-term biochemical adaptations in neurons following cortical injury.
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Affiliation(s)
- J W Sharp
- Department of Neurology, University of California, San Francisco
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Peedicayil A, Jasper P, Balasubramaniam N, Jairaj P. A randomized controlled trial of extra-amniotic ethinyloestradiol for cervical ripening in multiparas. Aust N Z J Obstet Gynaecol 1990; 30:127-30. [PMID: 2205188 DOI: 10.1111/j.1479-828x.1990.tb03241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 12/30/2022]
Abstract
A double-blind randomized controlled trial was carried out to determine if ethinyloestradiol applied extra-amniotically would ripen the unfavourable cervix at term. Twenty five multiparas were given 150 mg ethinyloestradiol gel while 25 multiparas were given gel alone. There was no difference between the ethinyloestradiol and control groups in either mean change of Bishop score or the induction-to-delivery interval.
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Affiliation(s)
- A Peedicayil
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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Jasper P, Peedicayil A, Nair S, George RK. Hydatid cyst obstructing labour: a case report. J Trop Med Hyg 1989; 92:393-5. [PMID: 2607572] [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: 01/01/2023]
Abstract
A case of pelvic hydatid cyst obstructing labour is described in this report. Medical and surgical aspects of management are also discussed.
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Affiliation(s)
- P Jasper
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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Peedicayil A, Jasper P, Balasubramaniam N, Jairaj P. A randomized controlled trial of extra-amniotic ethinyloestradiol in ripening the cervix at term. Br J Obstet Gynaecol 1989; 96:973-7. [PMID: 2673340 DOI: 10.1111/j.1471-0528.1989.tb03357.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A double-blind randomized controlled trial investigated the use of extra-amniotic ethinyloestradiol for ripening the unfavourable cervix at term. Twenty-five primigravidae were treated with 150 mg ethinyloestradiol gel while 24 primigravidae were treated with gel alone. There was no statistical difference between the ethinyloestradiol and control groups in either mean change in Bishop score or the induction-to-delivery interval.
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Affiliation(s)
- A Peedicayil
- Department of Obstetrics and Gynaecology, Christian Medical College and Hospital, Vellore, India
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Abstract
To evaluate the necessity of an excretory urogram before prostatectomy the records of 557 patients admitted to 3 community hospitals in 1977 and 1978 for urinary obstruction were reviewed. Of the entire series 27 per cent revealed urographic abnormalities and 72 significant lesions of the upper urinary tract were noted. An operation other than prostatectomy was necessary in 14 cases. Abnormalities involving the bladder were detected in 29 cases. We conclude that excretory urography remains a sound principle of proper urologic care.
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Zannoni D, Jasper P, Marrs B. Light-induced oxygen reduction as a probe of electron transport between respiratory and photosynthetic components in membranes of Rhodopseudomonas capsulata. Arch Biochem Biophys 1978; 191:625-31. [PMID: 742893 DOI: 10.1016/0003-9861(78)90400-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Separate divalent cation transport systems for energy-dependent uptake of Mg2+ and Mn2+ were found both with aerobically and heterotrophically grown and with photosynthetically grown cells of Rhodopseudomonas capsulata. The maximum rate of Mg2+ uptake differed between photosynthetic and aerobic cells, while the Km for the Mg2+ transport system was constant. Photosynthetic midlog-phase cells exhibited Km's for uptake of about 55 micrometer Mg2+ and 0.5 micrometer Mn2+. The Vmax's also differed between the two systems: 0.6 to 1.8 mumol/min per g (dry weight) of cells for Mg2+, but only 0.020 mumol/min per g for Mn2+, making the distinction between a "macro-requirement" system and a system functioning at trace nutrient levels. Calcium was not normally taken up by intact cells of R. capsulata. However, chromatophore membranes isolated from photosynthetic cells took up Ca2+ by an energy-dependent process.
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Abstract
Rhodopseudomonas capsulata required potassium (or rubidium or cesium as analogs of potassium) for growth. These cations were actively accumulated by the cells by a process following Michaelis-Menten saturation kinetics. The monovalent cation transport system had Km's of 0.2 mM K+, 0.5 mM Rb+, and 2.6 mM Cs+. The rates of uptake of substrates by the potassium transport system varied with the age of the culture, although the affinity constant for the substrates remained constant. The maximal velocity of uptake of K+ was lower in aerobically grown cells than in photosynthetically grown cells, although the Km's for K+ and for Rb+ were about the same.
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Jasper P, Whitney E, Silver S. Genetic locus determining resistance to phage BF23 and colicins E 1 , E 2 and E 3 in Escherichia coli. Genet Res (Camb) 1972; 19:305-12. [PMID: 4561717 DOI: 10.1017/s0016672300014555] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
SUMMARYThe gene for resistance to phage BF23 and colicins E1, E2and E3,bfe, was mapped by a combination of conjugation and transduction crosses. Co-transduction ofbfewas found with markers in the region between 76 and 79 min on theEscherichia coligenetic map. The highest frequency of co-transduction was found withargH(47%). Three-factor transductional crosses showed unambiguously thatbfelies betweenargHandsupM, at about 77·5 min on the map.
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