RESUMEN
OBJECTIVES: To evaluate the efficacy and safety of ianalumab (VAY736), a B cell-depleting, B cell activating factor receptor-blocking, monoclonal antibody, in patients with active primary Sjögren's syndrome (pSS) in a double-blind, placebo-controlled, phase II, single-centre study. METHODS: Patients with pSS, EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) ≥6, were randomised to ianalumab single infusion at either 3 mg/kg (n=6), 10 mg/kg (n=12) or placebo (n=9). Outcomes were measured blinded at baseline and weeks 6, 12, 24, and unblinded at end of study (EoS) when B cell numbers had recovered. Clinical outcomes included ESSDAI, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), salivary flow rate, ocular staining score, physician global assessment and patient assessments of fatigue and general quality of life. Laboratory-based measures included circulating leucocyte subsets and markers of B cell activity. RESULTS: A similar trend showing positive therapeutic effect by ianalumab was observed across the primary clinical outcome (ESSDAI) and all secondary clinical outcomes (ESSPRI, Multidimensional Fatigue Inventory, Short Form-36, global assessments by physician and patient) versus the placebo-treated group. Rapid and profound B cell depletion of long-lasting duration occurred after a single infusion of ianalumab at either dose. Serum Ig light chains decreased, with return to baseline levels at EoS. Changes in some clinical outcomes persisted through to EoS in the higher dose group. Adverse effects were largely limited to mild to moderate infusion reactions within 24 hours of ianalumab administration. CONCLUSIONS: Overall results in this single-dose study suggest potent and sustained B cell depletion by ianalumab could provide therapeutic benefits in patients with pSS without major side effects.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Citotoxicidad Celular Dependiente de Anticuerpos/efectos de los fármacos , Receptor del Factor Activador de Células B/antagonistas & inhibidores , Linfocitos B/efectos de los fármacos , Síndrome de Sjögren/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anticuerpos Monoclonales/inmunología , Anticuerpos Monoclonales Humanizados/inmunología , Citotoxicidad Celular Dependiente de Anticuerpos/inmunología , Receptor del Factor Activador de Células B/inmunología , Linfocitos B/inmunología , Método Doble Ciego , Fatiga/tratamiento farmacológico , Fatiga/etiología , Fatiga/inmunología , Femenino , Humanos , Activación de Linfocitos/efectos de los fármacos , Activación de Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
In humans, increased red blood cell distribution width (RDW) values are associated with higher morbidity and mortality in a variety of pathological processes. The main objective of this study was to evaluate RDW in dogs with a diverse range of pathologies. Clinical data from 276 dogs were retrospectively evaluated. Significantly higher RDW values were found in dogs with primary immune-mediated hemolytic anemia (P < 0.0001), immune-mediated thrombocytopenia (P < 0.0004), hyperadrenocorticism (P < 0.0001), hypothyroidism (P = 0.0220), hepatic vascular anomaly (P < 0.0001), pneumonia (P < 0.0001), chronic kidney disease (P = 0.0005), multi-centric lymphoma (P = 0.0002), and myxomatous mitral valve degeneration (P = 0.0032). However, there was extensive overlap with the values from healthy dogs, limiting the diagnostic value of RDW in this setting. Although RDW may have a role as a potential prognostic indicator, further studies would be necessary to address this.
Évaluation de l'indice de distribution des globules rouges chez des chiens avec différentes maladies. Chez les humains, une augmentation des valeurs de l'indice de distribution des globules rouges (RDW) est associée avec une plus grande morbidité et mortalité dans une variété de processus pathologiques. L'objectif principal de la présente étude était d'évaluer la RDW chez des chiens avec une variété de pathologies. Les données cliniques de 276 chiens ont été rétrospectivement évaluées. Des valeurs significativement plus élevées de RDW ont été trouvées chez des chiens avec une anémie hémolytique primaire à médiation immunitaire (P < 0,0001), une thrombocytopénie à médiation immunitaire (P < 0,0004), de l'hyperadrénocorticisme (P < 0,0001), de l'hypothyroïdisme (P < 0,0220), une anomalie vasculaire hépatique (P < 0,0001), une pneumonie (P < 0,0001), une maladie rénale chronique (P = 0,0005), un lymphome multicentrique (P = 0,0002), et une dégénérescence myxomateuse de la valvule mitrale (P = 0,0032). Toutefois, il y avait un chevauchement important avec les valeurs provenant de chiens en santé, limitant ainsi la valeur diagnostique de RDW dans ce contexte. Bien que le RDW peut avoir un rôle d'indicateur potentiel de pronostic, des études supplémentaires seraient nécessaires pour y répondre.(Traduit par Dr Serge Messier).
Asunto(s)
Hiperfunción de las Glándulas Suprarrenales/veterinaria , Índices de Eritrocitos/veterinaria , Animales , Enfermedades de los Perros , Perros , Eritrocitos , Humanos , Pronóstico , Estudios RetrospectivosRESUMEN
Extracellular vesicles (EVs) are nanoparticles found in all biological fluids, capable of transporting biological material around the body. Extensive research into the physiological role of EVs has led to the development of the Minimal Information for Studies of Extracellular Vesicles (MISEV) framework in 2018. This framework guides the standardisation of protocols in the EV field. To date, the focus has been on EVs of human origin. As comparative medicine progresses, there has been a drive to study similarities between diseases in humans and animals. To successfully research EVs in felines, we must validate the application of the MISEV guidelines in this group. EVs were isolated from the plasma of healthy humans and felines. EV characterisation was carried out according to the MISEV guidelines. Human and feline plasma showed a similar concentration of EVs, comparable expression of known EV markers and analogous particle to protein ratios. Mass spectrometry analyses showed that the proteomic signature of EVs from humans and felines were similar. Asymmetrical flow field flow fractionation, showed two distinct subpopulations of EVs isolated from human plasma, whereas only one subpopulation was isolated from feline plasma. Metabolomic profiling showed similar profiles for humans and felines. In conclusion, isolation, and characterisation of EVs from humans and felines show that MISEV2018 guidelines may also be applied to felines. Potential comparative medicine studies of EVs may provide a model for studying naturally occurring diseases in both humans and felines.
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Vesículas Extracelulares , Fraccionamiento de Campo-Flujo , Animales , Transporte Biológico , Gatos , Humanos , Plasma , ProteómicaRESUMEN
AIM: To determine the potential of cortisol secretion, in response to a physiological stressor, as a biomarker for centrally active compounds targeting the hypothalamic-pituitary-adrenocortical (HPA) axis. METHODS: Cortisol response to hypoglycaemia was measured in 26 healthy males in two stages: firstly to derive an algorithm for individualized, graded insulin infusion rates to achieve defined hypoglycaemic targets over 3 h and secondly to determine the inter- and intra-subject variability of cortisol response to hypoglycaemia over two identical periods by measuring the maximum (t(max) ), time to maximum (C(max) ) response and cortisol area under the response curve (AUC). RESULTS: Hypoglycaemia induced a consistent cortisol response starting at approximately 1 h, corresponding to blood glucose concentrations of approximately 3.3 mmol l⻹, and peaking approximately 3 h after the start of infusion. The inter- and intra-subject coefficients of variation (CVs) of cortisol response were approximately 19 and 19% (AUC), 15 and 19 % (C(max) ) and 10 and 14% (t(max) ), respectively. The intra-subject CVs for the ratio of maximum cortisol response to baseline concentration and rate of initial cortisol response between study days were more variable (32.8% and 59.0%, respectively). The blood glucose-cortisol response model derived from the study was predictive of the individual observed cortisol responses, and estimated a blood glucose EC(50) associated with onset of the cortisol response of 3.3 mmol l⻹. CONCLUSIONS: Gradual hypoglycaemia is an effective, reproducible and well-tolerated method of stimulating a cortisol response and may therefore be useful in assessing the neuroendocrine response to HPA axis inhibitors, such as corticotropin-releasing hormone-1 (CRH-1) antagonists.
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Hidrocortisona/metabolismo , Hipoglucemiantes/farmacología , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Insulina/farmacología , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Humanos , Hidrocortisona/sangre , Hipoglucemia/inducido químicamente , Hipoglucemia/metabolismo , Hipoglucemiantes/administración & dosificación , Sistema Hipotálamo-Hipofisario/metabolismo , Insulina/administración & dosificación , Masculino , Persona de Mediana Edad , Proyectos Piloto , Sistema Hipófiso-Suprarrenal/metabolismo , Estrés Fisiológico/fisiología , Adulto JovenRESUMEN
Although relationship restoration is an important outcome of forgiveness, little is known about how forgiveness facilitates such an outcome. In addition, in forgiveness research, little attention is paid to the perspective of the offender. We address these two shortcomings simultaneously, testing the idea that forgiveness promotes offender gratitude, which in turn encourages offender pro-relational intentions. Across three experimental studies, participants were induced to believe they had transgressed; recalled a time when they had transgressed; and imagined transgressing. In studies 1 and 2, forgiveness was manipulated; in Study 3, victim motivation for forgiving was manipulated. State gratitude--in comparison with guilt, indebtedness, and positive affect--was consistently found to play the primary mediating role between forgiveness and pro-relational intentions.
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Perdón , Culpa , Intención , Relaciones Interpersonales , Motivación , Adolescente , Adulto , Actitud , Criminales , Femenino , Humanos , Masculino , Percepción Social , Adulto JovenRESUMEN
PURPOSE: The International Conference on Harmonisation E14 guideline mandates an intensive cardiac safety evaluation in a clinical thorough QT study, typically in healthy subjects, for all new non-antiarrhythmic drugs with systemic bioavailability. This thorough QT study investigated the effects of therapeutic (2 mg) and supratherapeutic (10 mg) doses of siponimod (BAF312) on cardiac repolarization in healthy subjects. METHODS: The study was a randomized, double-blind, parallel-group, placebo- and moxifloxacin-controlled, multiple oral dose study. Eligible subjects were randomly assigned to 3 groups to receive siponimod (up-titration to 2 and 10 mg over 18 days), placebo (Days -1 to 18), or moxifloxacin 400 mg Days 10 and 18). Triplicate ECGs were extracted at prespecified time points from Holter ECGs recorded from 1 hour predose until 24 hours postdose at baseline and on-treatment assessment Days 10 and 18. The primary pharmacodynamic variable was the time-matched, placebo-corrected, baseline-adjusted mean QTcF (ΔΔQTcF) at steady-state conditions. In addition, the pharmacokinetic parameters of siponimod and its main circulating metabolite M3 and its metabolite M5 were evaluated. FINDINGS: Of the 304 enrolled subjects, 281 (92.4%) were included in the pharmacodynamic analysis and 270 (88.8%) completed the study. The upper bounds of the 2-sided 90% confidence intervals (CIs) for ΔΔQTcF at both siponimod doses were within the regulatory threshold of 10 milliseconds (ms) at all predefined on-treatment time points, with the absence of any dose-related effects. The highest observed upper limits of the 2-sided 90% CIs of 9.8 and 9.6 ms for therapeutic and supratherapeutic doses, respectively, were both observed at 3 hours postdose. No treatment-emergent QTc values >480 ms and no QTc increases of >60 ms from baseline were observed. Similar results were obtained with individualized heart rate correction of cardiac repolarization (QTcI). Assay validity was demonstrated by maximum ΔΔQTcF of >5 ms after 400 mg moxifloxacin on both on-treatment assessment days. The selected supratherapeutic dose produced approximately 5-fold higher exposures (Cmax and AUC) than the therapeutic dose, and was considered appropriate to investigate the effects of siponimod on QT/QTc at substantial multiples of the anticipated maximum therapeutic exposure. IMPLICATIONS: The findings provide evidence that siponimod is not associated with a significant arrhythmogenic potential related to QT prolongation.