A trial design to maximize knowledge of the effects of rodatristat ethyl in the treatment of pulmonary arterial hypertension (ELEVATE 2).

Serotonin plays a key role in the development and maintenance of the pathobiology associated with pulmonary arterial hypertension (PAH). Platelet-driven and locally produced serotonin from lung tissue and arterial endothelial cells induce excessive growth of pulmonary artery smooth muscle cells. The unchecked growth of these cells is a major driver of PAH including the remodeling of pulmonary arteries that dramatically reduces the diameter and flexibility of the arterial lumen. Tryptophan hydroxylase 1 (TPH1) is the rate-limiting enzyme for biosynthesis of serotonin and is upregulated in PAH arterial endothelial cells, supporting TPH1 inhibition to treat PAH. Targeting the serotonin pathway via inhibition of peripheral serotonin and local production in diseased tissues, rather than individual receptor-mediated or receptor-independent mechanisms, may result in the ability to halt or reverse pulmonary vascular remodeling. Rodatristat ethyl, a prodrug for rodatristat, a potent, peripheral inhibitor of TPH1, has demonstrated efficacy in monocrotaline and SUGEN hypoxia nonclinical models of PAH and robust dose-dependent reductions of 5-hydroxyindoleacetic acid, the major metabolite of serotonin in plasma and urine of healthy human subjects. ELEVATE 2 (NCT04712669) is a Phase 2b, double-blind, multicenter trial where patients with PAH are randomized to placebo, 300 or 600 mg twice daily of rodatristat ethyl. The trial incorporates endpoints to generate essential clinical efficacy, safety, pharmacokinetic, and pharmacodynamic data needed to evaluate the ability of rodatristat ethyl to ameliorate PAH by halting or reversing pulmonary vascular remodeling through its unique mechanism of TPH1 inhibition. Herein we describe the experimental design highlighting the trial's unique features.

Fluid heterogeneity detection based on the asymptotic distribution of the time-averaged mean squared displacement in single particle tracking experiments.

A tracer particle is called anomalously diffusive if its mean squared displacement grows approximately as σ 2 t α as a function of time t for some constant σ 2, where the diffusion exponent satisfies α ≠ 1. In this article, we use recent results on the asymptotic distribution of the time-averaged mean squared displacement [20] to construct statistical tests for detecting physical heterogeneity in viscoelastic fluid samples starting from one or multiple observed anomalously diffusive paths. The methods are asymptotically valid for the range 0 < α < 3/2 and involve a mathematical characterization of time-averaged mean squared displacement bias and the effect of correlated disturbance errors. The assumptions on particle motion cover a broad family of fractional Gaussian processes, including fractional Brownian motion and many fractional instances of the generalized Langevin equation framework. We apply the proposed methods in experimental data from treated P. aeruginosa biofilms generated by the collaboration of the Hill and Schoenfisch Labs at UNC-Chapel Hill.