0487 Effects of Suvorexant on Sleep Architecture in Patients with Alzheimer’s Disease and Insomnia

Introduction

Suvorexant, an orexin receptor antagonist that enables sleep to occur via competitive antagonism of wake-promoting orexins, improved total sleep time (TST) in a sleep laboratory polysomnography (PSG) study of patients with AD and insomnia. Here we report on the effects of suvorexant on sleep architecture in the study.

Methods

This was a randomized, double-blind, 4-week trial (ClinicalTrials.gov NCT02750306). Participants who met diagnostic criteria for both probable AD dementia (of mild to moderate severity) and insomnia were randomized to suvorexant 10mg (could be increased to 20mg based on clinical response) or matching placebo. Overnight sleep laboratory PSG was performed on 3 nights: screening, baseline, and Night-29 (last night of dosing). Suvorexant differences from placebo in changes-from-baseline at Night-29 for sleep architecture were analyzed as exploratory endpoints.

Results

A total of 274 participants were included in the analysis (suvorexant N=135, placebo N=139). At Night-29, suvorexant improved TST by 28 minutes versus placebo (p=0.001). There were no significant differences between suvorexant and placebo in the % of TST spent in REM (1.3%, 95% CI: -0.5, 3.0), N1 (0.6%, 95% CI: -1.2, 2.5), N2 (-1.0%, 95% CI: -3.2, 1.2), or N3 (-0.6%, 95% CI: -1.8, 0.6). There was no significant difference between suvorexant and placebo in latency to REM (-5.4 minutes, 95% CI: -23.4, 12.7).

Conclusion

Suvorexant improves TST without altering the underlying sleep architecture in AD patients with insomnia.

Support

Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA

0488 Pilot Evaluation of an Actigraphy Watch Compared to Polysomnography in a Clinical Trial of Suvorexant for Treating Insomnia in Patients with Alzheimer’s Disease

Introduction

Suvorexant, an orexin receptor antagonist, improved total sleep time (TST) in a sleep laboratory polysomnography (PSG) study of patients with Alzheimer’s disease (AD) and insomnia. The study included a pilot evaluation of an actigraphy watch for continuously recording patient’s sleep and daytime activity. We report on the utility of the watch for assessing sleep in relation to gold-standard PSG.

Methods

This was a randomized, double-blind, 4-week trial (ClinicalTrials.gov NCT02750306). Participants who met diagnostic criteria for both probable AD dementia and insomnia were randomized to suvorexant 10-20mg or placebo. Overnight sleep laboratory PSG was performed on 3 nights: screening, baseline, and Night-29 (last dose). An actigraphy watch (Garmin vívosmart® HR) was worn continuously by the patient. Separate analyses were performed for PSG and watch. We compared treatment effects on change-from-baseline in PSG-TST at Night-29 and WATCH-TST at Week-4 (average TST per night over Week-4). We also analyzed Night-29 data only with watch data restricted to the PSG recording time.

Results

A total of 274 participants were included in the Night-29 PSG analysis (suvorexant=135, placebo=139) and 223 in the Week-4 watch analysis (suvorexant=113, placebo=110). Suvorexant improved Night-29 PSG-TST by 28 minutes versus placebo (p=0.001) and Week-4 WATCH-TST by 17 minutes versus placebo (p=0.144). In the subgroup who had usable data for both assessments at Night-29 (suvorexant=57, placebo=50), the watch overestimated TST compared to PSG (e.g. placebo baseline scores = 412 minutes for WATCH-TST and 265 minutes for PSG-TST) and underestimated change-from-baseline treatment effects: the suvorexant versus placebo difference was 35 minutes for PSG-TST (p=0.057) and 20 minutes for WATCH-TST (p=0.405).

Conclusion

The watch was less sensitive than PSG for evaluating treatment effects on TST. However, results obtained with the watch were directionally similar to PSG in indicating a benefit of suvorexant versus placebo for improving TST in AD patients with insomnia.

Support

Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA

Potential gains in lifetime net merit from genomic testing of cows, heifers, and calves on commercial dairy farms

The objective of this study was to quantify the gains in genetic potential of replacement females that could be achieved by using genomic testing to facilitate selection and culling decisions on commercial dairy farms. Data were simulated for 100 commercial dairy herds, each with 1,850 cows, heifers, and calves. Parameters of the simulation were based on the US Holstein population, and assumed reliabilities of traditional and genomic predictions matched reliabilities of animals that have been genotyped to date. Selection of the top 10, 20, 30, …, 90% of animals within each age group was based on parent averages and predicted transmitting abilities with or without genomic testing of all animals or subsets of animals that had been presorted by traditional predictions. Average gains in lifetime net merit breeding value of selected females due to genomic testing, minus prorated costs of genotyping the animals and their unselected contemporaries, ranged from $28 (top 90% selected) to $259 (top 20% selected) for heifer calves with no pedigrees, $14 (top 90% selected) to $121 (top 10% selected) for heifer calves with known sires, and $7 (top 90% selected) to $87 (top 20% selected) for heifer calves with full pedigrees. In most cases, gains in genetic merit of selected heifer calves far exceeded prorated genotyping costs, and gains were greater for animals with missing or incomplete pedigree information. Gains in genetic merit due to genomic testing were smaller for lactating cows that had phenotypic records, and in many cases, these gains barely exceeded or failed to exceed genotyping costs. Strategies based on selective genotyping of the top, middle, or bottom 50% of animals after presorting by traditional parent averages or predicted transmitting abilities were cost effective, particularly when pedigrees or phenotypes were available and a relatively small proportion of animals were to be selected or culled. Based on these results, it appears that routine genotyping of heifer calves or yearling heifers can be a cost-effective strategy for enhancing the genetic level of replacement females on commercial dairy farms. Increasing the accuracy of predicted breeding values for young females with genomic testing might lead to synergies with other management tools and strategies, such as propagating genetically superior females using advanced reproductive technologies or selling excess females that were generated by the use of sex-enhanced semen.

High Resolution Light Microscopic Evaluation of Boar Semen Quality Sperm Cytoplasmic Droplet Retention in Relationship with Boar Fertility Parameters

The purpose of this study was to investigate the relationship between fertility and quantitative measures of boar semen quality, including various patterns of sperm cytoplasmic droplet (CD) retention, as determined by high power differential interference contrast (DIC) microscopy. A total of 116 ejaculates were collected from a nucleus herd of 18 Large White boars over an eight month period. Semen quality parameters were analyzed for each ejaculate by calculating the percentage of normal spermatozoa, spermatozoa possessing a CD in the proximal, distal, or distal midpiece reflex position, total spermatozoa with an attached cytoplasmic droplet, spermatozoa with non-CD related aberrations and total spermatozoa with abnormalities. Of the 116 ejaculates received, 71 ejaculates from 13 boars had corresponding fertility data from single-sire inseminations of multiparous sows. The fertility data included farrowing rate (FR) and total number born (TNB). The monthly FR encompassed one month before and one month after the date of semen collection. Detection of differences for fertility and semen quality parameters was performed by separating the boars into either an above-average or below-average group based on the mean FR (74.01 +/- 1.43%) or TNB (12.34 +/- 0.17) for the study. For FR, the boars in the below-average group had a significantly lower percentage of normal spermatozoa and significantly higher percentage of spermatozoa possessing distal CDs, total attached CDs and total abnormalities compared to the boars in the above-average group. Conversely, for TNB there were no significant differences between the above- and below-average groups for the semen quality parameters. These data suggest that the attached CD may negatively affect FR, but not TNB. The detection of relationships between the boar fertility parameters and the retention of the sperm CD after ejaculation, document the advantage of high power DIC microscopy in conventional semen evaluation.

Estimation of variance components including competitive effects of Large White growing gilts

Records of on-test ADG of Large White gilts were analyzed to estimate variance components of direct and associative genetic effects. Models included the effects of contemporary group (farm-barn-batch), birth litter, pen group, and direct and associative additive genetic effects. The area of each pen was 14 m2. The additive genetic variance was a function of the number of competitors in a group, the additive relationships between the animal performing the record and its pen mates, and the additive relationships between pen mates. To partially account for differences in the number of pen mates, a covariable (qi = 1, 1/n, or 1/n(1/2)) was added to the associative genetic effect. There were 4,946 records from 2,409 litters and 362 pen groups. Pen group size ranged from 12 to 16 gilts. Analyses by REML converged very slowly. A grid search showed that the likelihood function was almost flat when the additive genetic associative effect was fitted. Estimates of direct and associative heritability were 0.15 and 0.03, respectively. Within the BLUPF90 family of programs, the mixed-model equations can be set up directly. For variance component estimation, simple programs (REMLF90 and GIBBSF90) worked without modifications, but more optimized programs did not. Estimates obtained using the three values of qi were similar. With the data structure available for this study and under an environment with relative low competition among animals, accurate estimation of associative genetic effects was not possible. Estimation of competitive effects with large pen size is difficult. The magnitude of competition effects may be larger in commercial populations, where housing is denser and food is limited.

Genetic correlations between two strains of Durocs and crossbreds from differing production environments for slaughter traits

The aim of this study was to estimate the genetic correlations between 2 purebred Duroc pig populations (P1 and P2) and their terminal crossbreds [C1 = P1 x (Landrace x Large White) and C2 = P2 x (Landrace x Large White)] raised in different production environments. The traits analyzed were backfat (BF), muscle depth (MD), BW at slaughter (WGT), and weight per day of age (WDA). Data sets from P1, P2, C1, and C2 included 26,674, 8,266, 16,806, and 12,350 animals, respectively. Two-trait models (nucleus and commercial crossbreds) for each group included fixed (contemporary group, sex, weight, and age), random additive (animal for P1 and P2 and sire for C1 and C2), random litter, and random dam (C1 and C2 only) effects. Heritability estimates (+/-SE) for BF were 0.46 +/- 0.04, 0.38 +/- 0.02, 0.32 +/- 0.02, and 0.33 +/- 0.02 for P1, P2, C1, and C2, respectively. Heritability estimates for MD were 0.31 +/- 0.01, 0.23 +/- 0.02, 0.19 +/- 0.01, and 0.12 +/- 0.01 for P1, P2, C1, and C2, respectively. The estimates for WGT and WDA were 0.31 +/- 0.01, 0.21 +/- 0.02, 0.16 +/- 0.01, and 0.18 +/- 0.01 and 0.32 +/- 0.01, 0.22 +/- 0.02, 0.16 +/- 0.01, and 0.19 +/- 0.01, respectively. Genetic correlations between purebreds and crossbreds for BF were 0.83 +/- 0.09 (P1 x C1) and 0.89 +/- 0.05 (P2 x C2), for MD 0.78 +/- 0.05 (P1 x C1) and 0.80 +/- 0.08 (P2 x C2). For WGT and WDA, the correlations were 0.53 +/- 0.08 (P1 x C1), 0.80 +/- 0.10 (P2 x C2), and 0.60 +/- 0.07 (P1 x C1) and 0.79 +/- 0.09 (P2 x C2), respectively. (Co)variances in crossbreds were adjusted to a live BW scale. Compared with purebreds, the genetic variances in crossbreds were lower, and the residual variances were greater. Sire variances in crossbreds were approximately 20 to 30% of the animal variances in purebreds for BF and MD but were 13 to 25% for WGT and WDA. The efficiency of purebred selection on crossbreds, assessed by EBV prediction weights, ranged from 0.43 to 0.91 for line 1 and 0.70 to 0.92 for line 2. When nucleus and commercial environments differ substantially, the efficiency of selection varies by line and traits, and selection strategies that include crossbred data from typical production environments may therefore be desirable.

Arachidonate 15-lipoxygenase and ubiquitin as fertility markers in boars

Accurate semen analysis is an important issue in the swine industry. We evaluated two candidate fertility marker proteins associated with sperm cytoplasmic droplet (CD), including 15-lipoxygenase (15-LOX) and ubiquitin (UBI) in a controlled single-sire artificial insemination (AI) trial. Ejaculates (n=116) were collected from 18 fertile Large White boars monthly for 8 mo, and analyzed by semi-quantitative, densitometry-based Western blotting and flow cytometry with antibodies against 15-LOX and UBI. Data were correlated with farrowing rates (FR) and total numbers of piglets born (TNB) from 1754 AI services by 13 of 18 boars, and compared with a conventional microscopic semen analysis. In semi-quantitative Western blotting, both 15-LOX and UBI were correlated with seasonal changes in the percentage of normal (r=-0.38, P<0.01; r=-0.27, P<0.05, respectively) and CD-bearing spermatozoa (r=0.35, P<0.01; r=0.27, P<0.05, respectively). In flow cytometry, UBI and 15-LOX levels showed seasonal changes coinciding with seasonal changes of FR and TNB, representing 13 boars, 88 ejaculates and 1,232 AI services. There were correlations between flow cytometric values of UBI and FR (r=0.31; P<0.05), adjusted FR (r=0.30; P<0.05), TNB (r=-0.38; P<0.01) and adjusted TNB (r=-0.37; P<0.01). Flow cytometric measurements of 15-LOX correlated negatively with TNB (r=-0.33; P<0.05) and adjusted TNB (r=-0.34; P<0.05). These data suggested that boar fertility estimation could be achieved within a group of fertile boars by the use of objectively measurable fertility markers. Flow cytometry appeared more informative and more practical than semi-quantitative Western blotting. This technology could be further optimized for the selection of the most fertile sires in an artificial insemination program.

Study of codes of disposal at different parities of Large White sows using a linear censored model

To study the genetic relationship between three grouped reasons for sow removal (SR) in consecutive parities, accounting for censoring, 13,838 records from Large White sows were analyzed. Data were from seven pure-line farms having, on average, 5.9% unknown SR. Three traits were subjectively defined, each corresponding to a classification of SR (reproductive [RR], nonreproductive [RN], and others [RO]). Records for each trait could take one of five categories, according to parity at removal (0 to 4 or later). A multivariate linear censored model was implemented. The model to estimate (co)variance components and parameters included the effects of year-season, region, contemporary group, and additive genetic effects. The most common SR was related to reproduction (48.5%). Diseases of different origin and cause, old age/parity, and sow death or loss accounted for about 18, 7, and 4% of total culls, respectively. Estimates of variance components showed heterogeneity of additive genetic and residual variances for the three traits. Estimates of heritability were 0.18, 0.13, and 0.15 for RR, RN, and RO, respectively. Genetic correlations between removal codes were high (> or =0.90). Results suggest sizeable additive genetic variances exist for parity at removal and different codes of removal. Different SR reasons seem to operate similarly or as a closely related genetic trait associated with fitness. In particular, RN and RO seem to be genetically indistinguishable. Data structure, definition, and volume are major limitations in studies of sow survival. A multiple-trait censored model is preferred to evaluate reasons of sow disposal. Grouped removal causes seem to be strongly genetically correlated but with heterogeneous variances, suggesting that combining all removal causes and treating the trait as parity at disposal is an alternative approach.

Threshold-linear estimation of genetic parameters for farrowing mortality, litter size, and test performance of Large White sows

Up to 109,447 records of 49,656 Large White sows were used to evaluate the genetic relationship between number of pigs born dead (BD) and number born alive (BA) in first and later parities. Performance data (n = 30,832) for ultrasound backfat (BF) at the end of the test and days to reach 113.5 kg (AD) were used to estimate their relationships with BD and BA at first parity in a four-trait threshold-linear analysis (TL). Effects were year-farm, contemporary group (CG: farm-farrowing year-farrowing month) and animal additive genetic. At first parity, estimates of heritability were 0.09, 0.09, 0.37, and 0.31 for BA, BD, AD, and BF, respectively. The estimate of genetic correlation between BD and litter size was -0.04 (BD-BA). Corresponding values with test traits were both -0.14 (BD-AD, BD-BF). Estimates of genetic correlation between BA and performance traits were 0.08 (BA-AD) and 0.05 (BA-BF). The two test traits were moderately negatively correlated (-0.22). For later parities, a six-trait (BD, BA in three parities) TL model was implemented. The estimates of additive genetic variances and heritability increased with parity for BD and BA. Estimates of heritabilities were: 0.09, 0.10, and 0.11 for BD, and 0.09, 0.12, and 0.12 for BA in parities one to three, respectively. Estimates of genetic correlations between different parities were high (0.91 to 0.96) for BD, and slightly lower (0.74 to 0.95) for BA. Genetic correlations between BD and BA were low and positive (0.02 to 0.17) for BA in Parities 1 and 2, but negative (-0.04 to -0.10) for BA in Parity 3. Selection for increased litter size should have little effect on farrowing piglet mortality. Intense selection for faster growth and increased leanness should increase farrowing piglet mortality of first-parity sows. A repeatability model with a simple correction for the heterogeneity of variances over parities could be implemented to select against farrowing mortality. The genetic components of perinatal piglet mortality are independent of the ones for litter size in the first parity, and they show an undesirable, but not strong, genetic association in second parity.

Pre-clamp cardioprotection by protein kinase C (PKC) inhibitor improves left ventricular function following canine normothermic arrest

Since protein kinase C (PKC) has been proven to be a mediator of neutrophil activation and of intracellular calcium homeostasis, its inhibition could protect the myocardium from the deleterious effects of ischemic/reperfusion inury (IRI). The principal objective of this study was to evaluate the efficacy of the PK inhibitor SPC-100270 (2S,3S)-2-amino, 3-octadecanediol in a canine model of IRI. A double-blind study was conducted in which 19 coonhound dogs received either SPC-100270 or a vehicle before going on cardiopulmonary bypass (CPB). After 60 minutes of global normothermic (37 degree C) cardiac arrest (cross-clamp time 65-81 minutes for SPC-100270 and 65-72 minutes for control) and discontinuation of CBP, an epicardial short axis view echocardiogram was performed and reviewed by a double-blinded observer to determine the ejection fraction (EF). EF value exceeded 20% in 5 out of 9 SPC-100270 animals (27%-44%) and in 0 of 10 controls (0%-16%). These data show that SPC-10027 significantly (p=0.01 by Fisher's Exact Test) increased the probability that the animals would exhibit an EF greater than 20%.

Bacteremic pneumococcal pneumonia. A community hospital experience

We reviewed our experience with bacteremic pneumococcal pneumonia (BPP) over a 1-year period at a 600-bed community teaching hospital; 26 cases were identified. The mean age was 57.5 years and there were 12 male and 14 female subjects. Cough, sputum production, fever, and mental status changes were the most frequent symptoms. Risk factors included drug abuse in 10, HIV in 4, current smoking in 7, diabetes in 3, and cancer in 3. The mean PaO2/FIo2 ratio was 274. Radiographic features included a consolidation pattern in 7, bronchopneumonia in 15, combined in 1, and an initial normal film in 3. Average length of stay (LOS) was 11 days with an overall mortality of 11.5%. Four patients required mechanical ventilation, two meeting the criteria for ARDS (if this group were eliminated, LOS would be 8.4 days). Three of these survived. Four patients had organisms resistant to penicillin and all survived. We conclude that (1) BPP remains a serious but treatable infection particularly when utilizing full supportive care; (2) the bronchopneumonia x-ray film pattern was associated with all the mortality; and (3) the occurrence of penicillin resistance did not contribute to the mortality, since early recognition and the use of appropriate antibiotics saved all of these patients.