Very Rapid Improvement in Extended Nitric Oxide Parameters Is Associated With Clinical and Functional Improvement in Patients With Chronic Rhinosinusitis With Nasal Polyps Treated With Dupilumab.

BACKGROUND AND OBJECTIVE: Dupilumab, an anti-IL-4 receptor a monoclonal antibody, was recently approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and moderate-to-severe asthma. Onset of its clinical effects is rapid. CRSwNP is characterized by extended type 2 inflammatory involvement that can be assessed using extended nitric oxide analysis. We investigated whether dupilumab was associated with a rapid improvement in extended nitric oxide parameters, lung function, and clinical outcomes in patients with CRSwNP. METHODS: Consecutive patients with CRSwNP and an indication for dupilumab were evaluated for extended nitric oxide analysis (exhaled, FeNO; bronchial, JawNO; alveolar, CalvNO; nasal, nNO) and lung function 15 and 30 days after initiation of treatment and for clinical outcomes (nasal polyps score [NPS], quality of life questionnaires, visual analog scale [VAS] for the main symptoms, and the Asthma Control Test [ACT]) 30 days after initiation of treatment. RESULTS: We enrolled 33 patients. All extended nitric oxide and lung function parameters improved significantly after 15 days of treatment, remaining stable at 30 days. Scores on the NPS, VAS for the main RSwNP symptoms, quality of life questionnaires, and the ACT improved significantly 30 days after initiation of treatment. CONCLUSION: Dupilumab is associated with very rapid improvement in type 2 inflammation in all airway areas. This is associated with improved lung function and clinical parameters in patients with CRSwNP.

Very rapid improvement of extended nitric oxide parameters, associated with clinical and functional betterment, in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) treated with Dupilumab.

BACKGROUND AND OBJECTIVE: Background: Dupilumab, an anti-IL-4 receptor alpha monoclonal antibody, has been recently approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and moderate to severe asthma, demonstrating a rapid onset of clinical effects. CRSwNP is characterized by an extended type-2 inflammatory involvement that can be assessed by extended nitric oxide analysis. Objective: In this study we investigated whether Dupilumab is associated with a rapid improvement in extended nitric oxide parameters, lung function and clinical outcomes in patients with CRSwNP. METHODS: : Consecutive patients with CRSwNP and indication to be treated with Dupilumab were evaluated for extended nitric oxide analysis (exhaled, FENO; bronchial, JawNO and alveolar, CalvNO components; nasal, nNO) and lung function 15 and 30 days after treatment initiation, and for clinical outcomes (nasal polyps score, NPS; quality of life questionnaires; visual analogue scales, VAS, for main symptoms, asthma control test, ACT) after 30 days of treatment initiation. RESULTS: 33 patients were enrolled. All extended nitric oxide and lung function parameters significantly improved after 15 days of treatment remaining stable at 30 days. NPS, VAS for main CRSwNP symptoms, quality of life questionnaires and ACT significantly improved after 30 days of treatment initiation. CONCLUSION: Dupilumab is associated with very rapid improvement in type 2 inflammation in all airway districts and this is associated with improved lung function and clinical parameters in patients with CRSwNP.

Comorbid allergic rhinitis and asthma: important clinical considerations.

INTRODUCTION: The numerous links between allergic rhinitis and asthma have been extensively explored in the last two decades, gaining great concern within the scientific community. These two conditions frequently coexist in the same patient and share numerous pathogenetic and pathophysiological mechanisms. AREAS COVERED: We reviewed major pathophysiological, epidemiological, and clinical links between allergic rhinitis and asthma. We also provided a comprehensive discussion of allergic rhinitis treatment according to current guidelines, with a particular focus on the relevance of allergic rhinitis therapies in patients with comorbid asthma. EXPERT OPINION: We believe that there are several unmet needs for our patients, however, there are promising advances forecasted for the future. Although allergic rhinitis is a recognized risk factor for asthma, a proper asthma detection and prevention plan in allergic rhinitis patients is not available. Allergen immunotherapy (AIT) represents a promising preventive strategy and may deserve an earlier positioning in allergic rhinitis management. A multidisciplinary approach should characterize the journey of patients with respiratory allergies, with an adequate referral to specialized Allergy/Asthma centers. Molecular Allergy Diagnosis may provide support for optimal AIT use. Finally, a possible evolution of biological treatment can be envisaged, mainly if biosimilars decrease such therapies' costs.

Feasibility of a novel design of high resolution parallax-free Compton enhanced PET scanner dedicated to brain research.

A novel concept for a positron emission tomography (PET) camera module is proposed, which provides full 3D reconstruction with high resolution over the total detector volume, free of parallax errors. The key components are a matrix of long scintillator crystals and hybrid photon detectors (HPDs) with matched segmentation and integrated readout electronics. The HPDs read out the two ends of the scintillator package. Both excellent spatial (x, y, z) and energy resolution are obtained. The concept allows enhancing the detection efficiency by reconstructing a significant fraction of events which underwent Compton scattering in the crystals. The proof of concept will first be demonstrated with yttrium orthoaluminate perovskite (YAP):Ce crystals, but the final design will rely on other scintillators more adequate for PET applications (e.g. LSO:Ce or LaBr3:Ce). A promising application of the proposed camera module, which is currently under development, is a high resolution 3D brain PET camera with an axial field-of-view of approximately 15 cm dedicated to brain research. The design philosophy and performance predictions based on analytical calculations and Monte Carlo simulations are presented. Image correction and reconstruction tools required to operate this transmissionless device in a research environment are also discussed. Better or similar performance parameters were obtained compared to other known designs at lower fabrication cost. The axial geometrical concept also seems to be promising for applications such as positron emission mammography.

A Monte-Carlo based model of the AX-PET demonstrator and its experimental validation.

AX-PET is a novel PET detector based on axially oriented crystals and orthogonal wavelength shifter (WLS) strips, both individually read out by silicon photo-multipliers. Its design decouples sensitivity and spatial resolution, by reducing the parallax error due to the layered arrangement of the crystals. Additionally the granularity of AX-PET enhances the capability to track photons within the detector yielding a large fraction of inter-crystal scatter events. These events, if properly processed, can be included in the reconstruction stage further increasing the sensitivity. Its unique features require dedicated Monte-Carlo simulations, enabling the development of the device, interpreting data and allowing the development of reconstruction codes. At the same time the non-conventional design of AX-PET poses several challenges to the simulation and modeling tasks, mostly related to the light transport and distribution within the crystals and WLS strips, as well as the electronics readout. In this work we present a hybrid simulation tool based on an analytical model and a Monte-Carlo based description of the AX-PET demonstrator. It was extensively validated against experimental data, providing excellent agreement.

Minimal incidence of serum antibodies reactive with intact primary isolate virions in human immunodeficiency virus type 1-infected individuals.

Immunoglobulin G reactive with primary isolate virions was detected in 36% of serum samples from individuals infected with human immunodeficiency virus type 1. Of these individuals, serum samples from only 7% captured significant quantities of virus. Virion-specific antibody correlated with CD4 counts and, of more significance, primary isolate neutralization. Further dissection of this response should lead to the identification of antibodies and antigenic epitopes for vaccine purposes.