Erythropoietin in Spinocerebellar Ataxia Type 2: Feasibility and Proof-of-Principle Issues from a Randomized Controlled Study.

BACKGROUND: Several pieces of evidence have shown the neurotrophic effect of erythropoietin (EPO) and its introduction in the therapeutic practice of neurological diseases. However, its usefulness in the treatment of spinocerebellar ataxia type 2 (SCA2) has not been proven despite the fact that it is endogenously reduced in these patients. OBJECTIVE: The study aims to investigate the safety, tolerability, and clinical effects of a nasally administered recombinant EPO in SCA2 patients. METHODS: Thirty-four patients were enrolled in this double-blind, randomized, placebo-controlled, phase I-II clinical trial of the nasally administered human-recombinant EPO (NeuroEPO) for 6 months. The primary outcome was the change in the spinocerebellar ataxia functional index (SCAFI), while other motor, neuropsychological, and oculomotor measures were assessed. RESULTS: The 6-month changes in SCAFI score were slightly higher in the patients allocated to NeuroEPO treatment than placebo in spite of the important placebo effect observed for this parameter. However, saccade latency was significantly decreased in the NeuroEPO group but not in placebo. The frequency and severity of adverse events were similar between both groups, without evidences of hematopoietic activity of the drug. CONCLUSIONS: This study demonstrated the safety and tolerability of NeuroEPO in SCA2 patients after 6 months of treatments and suggested a small clinical effect of this drug on motor and cognitive abnormalities, but confirmatory studies are warranted. © 2022 International Parkinson and Movement Disorder Society.

Análisis de cinco años de resultados científicos en una Facultad de Ciencias Médicas / Analysis of five years of scientific results in a Faculty of Medical Sciences

RESUMEN Introducción: La producción científica es el conjunto de productos derivados de la actividad de investigación, donde destacan los artículos científicos, la presentación de trabajos en eventos científicos, premios, distinciones y muchos otros. Objetivo: Caracterizar la producción científica de los profesores de la Facultad de Ciencias Médicas Miguel Enríquez durante el periodo 2016-2020. Métodos: Se llevó a cabo un estudio observacional, descriptivo, de corte retrospectivo. El universo estuvo conformado por los resultados científicos anuales del claustro de profesores en relación con las publicaciones científicas, eventos científicos, premios y proyectos de investigación. Los artículos se clasificaron en grupos según las bases de datos a las que están indexadas. Adicionalmente, se analizaron los índices equivalentes por profesor de las publicaciones, proyectos, eventos y premios. Resultados: Se contabilizaron en total 403 publicaciones científicas, la cuarta parte de estas en el año 2020. Predominaron los trabajos publicados en editoriales nacionales, escritas en castellano, por profesores a tiempo completo. La investigación fue el campo que aportó la mayoría de publicaciones, indexadas en Scopus y otras bases de datos internacionales. Predominaron los eventos y premios de carácter nacional. Se presentaron como promedio unos 20 proyectos anuales. El índice de publicaciones equivalente por profesor, aunque bajo, evidenció una tendencia al incremento durante el periodo estudiado. Conclusiones: El análisis de cinco años de los resultados científicos del claustro de profesores de la Facultad de Ciencias Médicas Miguel Enríquez revela la necesidad imperiosa de incrementar la producción científica.

ABSTRACT Introduction: Scientific production is the set of products derived from research activity, where scientific articles, the presentation of studies at scientific events, awards, distinctions and many others stand out. Objective: To characterize the scientific production of the professors of the Faculty of Medical Sciences Miguel Enríquez during the period 2016-2020. Methods: An observational, descriptive, retrospective study was carried out. The universe was made up of the annual scientific results of the faculty in relation to scientific publications, scientific events, awards and research projects. The articles were classified into groups according to databases that were indexed. Additionally, equivalent professor indexes for publications, projects, events and awards studied were analyzed. Results: A total of 403 scientific publications were counted, a quarter of them in 2020. The works published in national publishers, written in Spanish, by full-time professors predominated. Research was the field that contributed most of publications, indexed in Scopus and other international database. National events and awards prevailed. An average of 20 projects were submitted per year. The index of publications per equivalent professor, although low, showed an upward trend during the studied period. Conclusions: The analysis of five years of scientific results of the Faculty of Medical Sciences Miguel Enríquez reveals the imperative need to increase scientific production.

Proyección estratégica para el desarrollo de las investigaciones en una Facultad de Ciencias Médicas / Strategic projection for the development of research in a Faculty of Medical Sciences

Introducción: En la Facultad de Ciencias Médicas Miguel Enríquez (FCM-ME) es necesario fortalecer el potencial investigativo y la producción científica de sus profesionales, con la finalidad de mejorar la calidad de los servicios de salud a nuestra población. Objetivo: Proponer un plan para el desarrollo de las investigaciones en la FCM-ME. Métodos: Se realizó un estudio descriptivo de tipo retrospectivo con la finalidad de recopilar información referente a las actividades y los resultados investigativos generados en la Facultad durante el periodo 2017-2020. Resultados: Durante el periodo de estudio la tercera parte de nuestros profesionales tienen una categoría docente de profesor titular o auxiliar; y del total el 2 % son investigadores auxiliares o titulares y el 3 por diento son doctores en ciencia. Respecto a la producción científica, el índice de proyectos y publicaciones nacionales por docente ha oscilado entre un 0,07-0,13; y el de publicaciones internacionales/docente ha sido de 0,03 durante los últimos 3 años. Estas cifras se han mantenido constantes durante los últimos años, por lo que se propone implementar un plan estratégico que permita el desarrollo de las investigaciones en la FCM-ME. Conclusiones: Se propone un plan estratégico para el desarrollo de las investigaciones en la Facultad de Ciencias Médicas Miguel Enríquez (AU)

ABSTRACT Introduction: At Miguel Enriquez Faculty of Medical Sciences (FCM-ME) it is necessary to strengthen the research potential and scientific production of its professionals, in order to improve the quality of health services to their population. Objective: Propose a strategic plan for the development of research in the FCM-ME. Methods: A retrospective descriptive study was carried out in order to collect information regarding the activities and research results generated in the faculty during the 2017-2020 period. Results: During the study period, a third of the professionals have a teaching category of full professor and/or assistant; and of the total, 2% are assistant and/or tenured researchers and only 3 % are PhD. Regarding scientific production, the index of national projects and publications per teacher has oscillated between 0.07-0.13; and that of international publications/teacher has been 0.03 during the last 3 years. These results have remained constant in past years, so it is proposed a strategic plan that allows the development of investigations in the FCM-ME. Conclusions: A strategic plan is proposed for the development of research in the Miguel Enríquez Faculty of Medical Sciences (AU)

Trabajo comunitario integrado de estudiantes de Ciencias Médicas frente a la COVID-19, Policlínico Rampa, 2020 / Integrated Community Work of Medical Sciences Students Facing COVID-19, Rampa Community Clinic, 2020

Introducción: En Cuba se realizan colosales esfuerzos para la prevención y control de la COVID-19, como es el pesquisaje activo realizado por estudiantes de Ciencias Médicas, a modo de trabajo comunitario integrado a la propia comunidad. Objetivo: Caracterizar el trabajo comunitario integrado desarrollado por estudiantes de Ciencias Médicas en el enfrentamiento a la COVID-19 en el área de salud del Policlínico Rampa. Métodos: Se realizó un estudio observacional de tipo descriptivo, retrospectivo, longitudinal, para analizar los datos provenientes del trabajo comunitario integrado. La pesquisa tuvo una primera etapa, entre marzo-julio 2020, al inicio de la pandemia en el país, y una segunda en septiembre-octubre 2020, dada la contingencia sanitaria existente en la capital. Se analizaron esencialmente las viviendas visitadas y las cerradas, personas pesquisadas, cantidad de adultos mayores, así como los sospechosos de contagio diarios. La evaluación del trabajo comunitario integrado se basó en la asistencia y la calidad de la pesquisa. Resultados: Se pesquisó como promedio por día el 21 por ciento del universo poblacional en la primera etapa y el 35 por ciento en la segunda etapa. El número de sospechosos detectados fue bajo. El número de viviendas visitadas y de adultos mayores pesquisados fue también superior durante la segunda etapa. Aunque el trabajo comunitario integrado fue más productivo y mejor evaluado en esa etapa, se consideró meritoria la pesquisa activa desarrollada por los estudiantes en ambos periodos. Conclusiones: El trabajo comunitario integrado realizado por estudiantes de las Ciencias Médicas, además de ser parte de su formación integral, representa un aporte necesario para enfrentar la COVID-19, de gran relevancia en un área con elevada prevalencia de adultos mayores(AU)

Introduction: In Cuba, boundless efforts are being made for the prevention and control of COVID-19, such as the active screening carried out by students of Medical Sciences, as a community work integrated into the community itself. Objective: To describe the integrated community work fulfilled by students of Medical Sciences in the confrontation with COVID-19 in the health area of Rampa community clinic. Methods: An observational, descriptive, retrospective, longitudinal study was carried out to analyze the data from integrated community work. The investigation had a first stage, from March to July 2020, at the beginning of the pandemic in the country, and a second stage from September to October 2020, given the existing health contingency in the capital city. Essentially, the homes visited and closed were analyzed, as well as the people surveyed, the number of older adults, and the daily contagion suspects. The evaluation of integrated community work was based on the assistance and the quality of the research. Results: An average of 21percent of the population universe was surveyed per day in the first stage and 35percent in the second stage. The number of suspects detected was low. The number of homes visited and aged adults surveyed was also higher during the second stage. Although integrated community work was more productive and better evaluated in this stage, the active research carried out by the students in both periods was considered meritorious. Conclusions: The integrated community work carried out by students of Medical Sciences, in addition to being part of their comprehensive training, represents a necessary contribution to face COVID-19, of great relevance in an area with a high prevalence of aged adults(AU)

Nasal administration of the neuroprotective candidate NeuroEPO to healthy volunteers: a randomized, parallel, open-label safety study.

BACKGROUND: Delivery of therapeutic agents as erythropoietin (EPO) into Central Nervous System through intranasal route could benefit patients with neurological disorders. A new nasal formulation containing a non-hematopoietic recombinant EPO (NeuroEPO) has shown neuroprotective actions in preclinical models. In the current study, the safety of NeuroEPO was evaluated for the first time in humans. METHODS: A phase I, randomized, parallel, open-label study was carried out in healthy volunteers. They received, intranasally, 1 mg of NeuroEPO every 8 h during 4 days (Group A) or 0.5 mg of NeuroEPO (Group B) with the same schedule. The working hypothesis was that intranasal NeuroEPO produce <10% of severe adverse reactions in the evaluated groups. Therefore, a rigorous assessment of possible adverse events was carried out, which included tolerance of the nasal mucosa and the effect on hematopoietic activity. Clinical safety evaluation was daily during treatment and laboratory tests were done before and on days 5 and 14 after starting treatment. RESULTS: Twenty-five volunteers, 56% women, with a mean age of 27 yrs. were included. Twelve of them received the highest NeuroEPO dose. Twenty types of adverse events occurred, with headache (20%) and increase of hepatic enzymes (20%) as the most reported ones. Nasopharyngeal itching was the most common local event but only observed in four patients (16%), all of them from the lowest dose group. About half of the events were very probably or probably caused by the studied product. Most of the events were mild (95.5%), did not require treatment (88.6%) and were completely resolved (81.8%). No severe adverse events were reported. During the study the hematopoietic variables were kept within reference values. CONCLUSIONS: NeuroEPO was a safe product, well tolerated at the nasal mucosa level and did not stimulate erythropoiesis in healthy volunteers. TRIAL REGISTRATION: Cuban Public Registry of Clinical Trials RPCEC00000157 , June 10, 2013.

Pharmacokinetic and pharmacodynamic characterization of a novel formulation containing co-formulated interferons alpha-2b and gamma in healthy male volunteers.

BACKGROUND: More potent antitumor activity is desired in Interferon (IFN)-treated cancer patients. This could be achieved by combining IFN alpha and IFN gamma. The aim of this work was to characterize the pharmacokinetics and pharmacodynamics of a novel formulation containing a co-formulated combination of IFNs alpha-2b and gamma (CIGB-128-A). METHODS: A group of nine healthy male subjects received intramuscularly 24.5 × 106 IU of CIGB-128-A. IFN concentrations were evaluated for 48 h. Serum neopterin, beta2-microglobulin (ß2M) and 2'-5' oligoadenylate synthetase (2'-5' OAS), classical IFN-inducible serum markers, were measured during 192 h by enzyme immunoassay and body temperature was used as pharmacodynamic variable as well. RESULTS: Concerning pharmacokinetics, serum IFNs' profiles were better fitted to a mono-compartmental model with consecutive zero order and first order absorption, one bioavailability value. No interferences by simultaneous administered IFNs were observed in their typical similar systemic profiles. Neopterin and ß2M time profiles showed a delay that was efficiently linked to pharmacokinetics by means of a zero order absorption rate constant. Neopterin level was nine-fold higher than initial values, 48 h post-administration, an increment not described before. At this time, mean serum ß2M peaked around the double from baseline. Serum concentrations of the enzyme 2'-5' OAS was still elevated on the 8 day post-injection. The formulation was well tolerated. Most frequent adverse reactions were fever, headache, arthralgia and lymphopenia, mostly mild. CONCLUSIONS: The administration of co-formulated IFN alpha-2b and IFN gamma likely provides improved pharmacodynamic properties that may be beneficial to treat several malignancies. TRIAL REGISTRATION: Cuban Public Registry of Clinical Trials RPCEC00000118 , May 24, 2011.

Enfermedad granulomatosa crónica / Chronic granulomatous disease

La enfermedad granulomatosa crónica (EGC) es una inmunodeficiencia primaria de la fagocitosis. Se presenta un paciente de 13 años de edad que a partir el mes de nacido presentó infecciones recurrentes: diarreas, neumonías, tuberculosis pulmonar, gingivo-estomatitis, celulitis, adenitis, abscesos cutáneos y hepáticos recidivantes. Al examen físico presentó una disminución severa del peso y la talla para la edad, palidez cutáneo-mucosa, periodontitis crónica, hiperlaxitud, aumento del hemiabdomen derecho y adenopatías generalizadas. Los estudios inmunológicos mostraron concentraciones normales de las inmunoglobulinas (Ig) séricas IgM: 0,98 g/L (0,69 - 2,69 g/L), IgA: 2,76 g/L (1,58 - 3,94 g/L) e IgE: 11,70 UI/ml (hasta 50 UI/mL), respectivamente, y ligeramente aumentadas de IgG: 17,2 g/L (7,81 - 15,30 g/L), C3 y C4 normales: 1,28 g/L (0,9 - 1,7 g/L) y 0,30 g/L (0,2 - 0,4 g/L), respectivamente. Las subpoblaciones linfocitarias T CD3, CD4 y CD8 positivas estuvieron normales: 62 por ciento (52 - 78 por ciento), 45 por ciento (25 - 48 por ciento) y 15 por ciento (9 - 35 por ciento), y los linfocitos B CD19 positivos estuvieron normales: 24 por ciento (8 - 24 por ciento). El índice opsonofagocítico mostró valores normales en los tiempos 15 y 60 min: 35 por ciento (22,99 - 53,95 por ciento) y 12,50 por ciento (6,63 - 28,4 3 por ciento). La prueba de reducción de nitroazul de tetrazolium espontánea y con agente inductor (Cándida albicans) fue negativa. Se concluyó como una EGC ligada al cromosoma X. El tratamiento incluyó el drenaje de los abscesos hepáticos recidivantes, uso de antimicrobianos y antimicóticos potentes e interferón gamma, con lo que disminuyó la frecuencia e intensidad de las infecciones. El diagnóstico y el tratamiento precoces de la EGC disminuyen la morbilidad y mortalidad de estos enfermos...

Chronic granulomatous disease (CGD) is a primary immunodeficiency with a defect of the phagocytosis process. A 13 year-old adolescent with recurrent life-threatening episodes since one month of birth is presented. The main clinical manifestations included diarrhea, stomatitis, cellulitis, lymphadenitis, pneumonia, granuloma formation, pulmonary tuberculosis, pulmonary and hepatic abscesses. Physical examination showed poor growth, hepatomegaly, adenopathies, hyperextension of extremities and chronic gingivitis. Immunological studies showed normal concentrations of immunoglobulins (Ig): IgM: 0,98 g/L (0,69 - 2,69 g/L), IgA: 2,76 g/L (1,58 - 3,94 g/L) and IgE: 11,70 UI/mL ( < 50 UI/ml), C3 and C4 (1,28 g/L (0,9 - 1,7 g/L) and 0,30 g/L (0,2 - 0,4 g/L), respectively, and hypergammaglobulinemia of 17,2 g/L (7,81 - 15,30 g/L). Lymphocytes count T CD3, CD4 and CD8 positive were normal: 62 percent (52 - 78 percent), 45 percent (25 - 48 percent) y 15 percent (9 - 35 percent) and B lymphocytes count was also normal: 24 percent (8 - 24 percent). Opsonophagocytic index was normal at time 15 and 60 minutes: 35 percent (22,99 - 53,95 percent) and 12,50 percent (6,63 - 28,43 percent), respectively. Diagnosis was confirmed with negative nitroblue tetrazolium test . Treatment with antibiotics, fungistats, as well as gamma interferon contributed to a favorable response, presenting a lower amount of infectious episodes as well as a recovery of weight and height. Early diagnosis and treatment of CGD has improved prognosis and reduced patients´ morbidity and mortality...

Pharmacokinetic and pharmacodynamic characterization of a new formulation containing synergistic proportions of interferons alpha-2b and gamma (HeberPAG) in patients with mycosis fungoides: an open-label trial.

BACKGROUND: The synergistic combination of interferon (IFN) alpha-2b and IFN gamma results in more potent in vitro biological effects mediated by both IFNs. The aim of this investigation was to evaluate by first time the pharmacokinetics and pharmacodynamics of this combination in patients with mycosis fungoides. METHODS: An exploratory, prospective, open-label clinical trial was conducted. Twelve patients, both genders, 18 to 75 years-old, with mycosis fungoides at stages IB to III, were eligible for the study. All of them received intramuscularly a single high dose (23 × 10(6) IU) of a novel synergistic IFN mixture (HeberPAG) for pharmacokinetic and pharmacodynamic studies. Serum IFN alpha-2b and IFN gamma concentrations were measured during 96 hours by commercial enzyme immunoassays (EIA) specific for each IFN. Other blood IFN-inducible markers and laboratory variables were used as pharmacodynamics and safety criteria. RESULTS: The pharmacokinetic evaluation by EIA yielded a similar pattern for both IFNs that are also in agreement with the well-known described profiles for these molecules when these are administered separately. The average values for main parameters were: Cmax: 263 and 9.3 pg/mL; Tmax: 9.5 and 6.9 h; AUC: 4483 and 87.5 pg.h/mL, half-life (t(1/2)): 4.9 and 13.4 h; mean residence time (MRT): 13.9 and 13.5 h, for serum IFN alpha-2b and IFN gamma, respectively. The pharmacodynamic variables were strongly stimulated by simultaneous administration of both IFNs: serum neopterin and beta-2 microglobulin levels (ß2M), and stimulation of 2'-5' oligoadenylate synthetase (OAS1) mRNA expression. The most encouraging data was the high increment of serum neopterin, 8.0 ng/mL at 48 h, not been described before for any unmodified or pegylated IFN. Additionally, ß2M concentration doubled the pre-dose value at 24-48 hours. For both variables the values remained clearly upper baseline levels at 96 hours. CONCLUSIONS: HeberPAG possesses improved pharmacodynamic properties that may be very useful in the oncologic setting. Efficacy trials can be carried out to confirm these findings. TRIAL REGISTRATION: Registro Público Cubano de Ensayos Clínicos RPCEC00000130.

Pharmacokinetic and pharmacodynamic comparison of two "pegylated" interferon alpha-2 formulations in healthy male volunteers: a randomized, crossover, double-blind study.

BACKGROUND: Interferon (IFN) alpha conjugation to polyethylene glycol (PEG) results in a better pharmacokinetic profile and efficacy. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of a new, locally developed, 40-kDa PEG-IFN alpha-2b preparation with a reference, commercially available PEG-IFN alpha-2a in healthy male volunteers. METHODS: A randomized, crossover, double-blind study with a 3-weeks washout period, was done. A single 180 micrograms PEG-IFN alpha-2 dose was administered subcutaneously in both groups. Sixteen apparently healthy male subjects were included. Serum PEG-IFN concentration was measured during 336 hours by an enzyme immunoassay (EIA). Other clinical and laboratory variables were used as pharmacodynamic and safety criteria. RESULTS: The pharmacokinetic comparison by EIA yielded a high similitude between the formulations. In spite of a high subject variability, the parameters' mean were very close (in all cases p > 0.05): AUC: 53623 vs. 44311 pg.h/mL; Cmax: 333 vs. 271 pg/mL; Tmax: 54 vs. 55 h; half-life (t1/2): 72.4 vs. 64.8 h; terminal elimination rate (lambda): 0.011 vs. 0.014 h(-1); mean residence time (MRT): 135 vs. 123 h for reference and study preparations, respectively. There were no significant differences with respect to the pharmacodynamic variables either: serum neopterin and beta-2 microglobulin levels, stimulation of 2'5' oligoadenylate synthetase expression, and serum IFN antiviral activity. A strong Spearman's rank order correlation (p < 0.01) between the pharmacokinetic and pharmacodynamic concentration-time curves was observed. Both products caused similar leukocyte counts diminution and had similar safety profiles. The most frequent adverse reactions were leukopenia, fever, thrombocytopenia, transaminases increase and asthenia, mostly mild. CONCLUSIONS: Both formulations are fully comparable from the pharmacokinetic, pharmacodynamic, and safety profiles. Efficacy trials can be carried out to confirm clinical similarity.

Interferón gamma recombinante como alternativa terapéutica en niños con artritis idiopática juvenil / Recombinant gamma Interferon as a therapeutical alternative in children with juvenile idiopathic arthritis

INTRODUCCIÓN. La artritis idiopática juvenil (AIJ) es una enfermedad del colágeno caracterizada por sinovitis crónica y síntomas extraarticulares, de inicio antes de los 16 años de edad. El interferón gamma (INFγ) mostró eficacia en un ensayo anterior con pacientes resistentes o intolerantes a las otras terapias disponibles, por lo que se decidió evaluar su eficacia y seguridad como medicamento modificador de la evolución de esta enfermedad. MÉTODOS. Se realizó un ensayo clínico abierto, no controlado, en el que se administró INFγ por vía intramuscular en dosis de 50 000 UI/kg (hasta 1 x 10(6) UI) durante 2 años. En el ensayo se incluyeron 20 pacientes con AIJ: 5 tenían la forma pauciarticular; 9, la poliarticular y 6, la sistémica. RESULTADOS. Al final del tratamiento, 13 pacientes (65 por ciento) se evaluaron como respondedores. El número de articulaciones afectadas, los síntomas sistémicos y los valores de eritrosedimentación y del cuestionario de calidad se redujeron significativamente. Igualmente disminuyó el número de pacientes que continuó consumiendo esteroides, así como la dosis de éstos. El tratamiento fue bien tolerado, excepto en 2 pacientes. CONCLUSIONES. El INFγ disminuye la expresión de la quimiocina CCR-4 en los niños, pero no en los adultos con la enfermedad. Es posible concluir que esta citocina puede ser una alternativa terapéutica eficaz en pacientes con AIJ; para confirmarlo se necesitan estudios controlados más extensos

INTRODUCTION: The juvenile idiopathic arthritis (JIA) is a collagen entity characterized by chronic synovitis and extra-articulation symptoms appearing before the 16 years old. Gamma Interferon (gamma-INF) showed its effectiveness in a prior trial with resistant and intolerant patients to other available gamma-INF therapies, thus authors assessed its effectiveness and safety as a modifier drug of the course of this entity. METHODS: An open clinical, no-controlled trial was carried out administering gammaINF by intramuscular route in doses of 50 000 IU/kg (up to 1 x 10(6) IU) during two years. Trial included 20 patients with JIA: five had the pauciarticular type; nine had the polyarticular one and six had the systemic one. RESULTS: At treatment termination, 13 patients (65 percent) were assessed as respondents. Figure of involved joints, the systemic symptoms and the erythrosedimentation values, and the quality questionnaire significantly decreased, as well as the figure of patients to continue consuming steroids and its dosage. Treatment was well tolerated, except 2 patients. CONCLUSIONS: Gamma-INF decrease the expression of CCR-4 chemokine in children, but not in adults ones presenting this entity. We conclude that this cytokine may be an efficient therapeutical alternative in patients with JIA; for its confirmation it is necessary more extent controlled studies

Reporte de dos casos de linfadenitis supurada causada por bacilo de Calmette-Guerin / Report of two cases of suppurated lymphadenitis caused by Bacillus Calmette-Guerin treated with recombinant ã-interferon

La linfadenitis supurada es una complicación poco frecuente que sigue a la vacunación con bacilo de Calmette-Guerin. Se describen los casos de dos niños con reacciones adversas graves inducidas por esta vacuna, en ambos casos, linfadenitis regional supurada y abscedada, un mes después de nacidos. Después de cursos infructuosos de cirugía y quimioterapia, ambos recibieron interferón gamma recombinante por vía intramuscular, en una dosis inicial de 50 000 UI/kg (máximo: 1 000 000 UI), diariamente durante las primeras 4 semanas, y se disminuyó luego la frecuencia de administración. Esta citoquina fue bien tolerada, solo se presentaron complicaciones con fiebre, que fueron controladas bien con antipiréticos. El interferón gamma recombinante puede constituir una nueva y efectiva alternativa terapéutica para el tratamiento de la linfadenitis supurada causada por este bacilo.

Suppurative lymphadenitis is a non frequent complication following Bacillus Calmette-Guerin (BCG) vaccination. Two paediatric patients with adverse reactions induced by the BCG vaccine are presented, both with suppurative and abscessed regional lymphadenitis, one month after birth. After failed courses of surgery and chemotherapy, they were treated with 50 000 IU/Kg (maximum: 1 000 000 IU) of recombinant interferon (IFN) gamma, intramuscularly, daily during 4 weeks and 3 or 2 tpw afterwards. The first case, a nursing girl with family history of tuberculosis, had a rapid involution of the lesions since the first month of treatment, with drainage ceasing and gradual disappearance of the inflammatory signs. At the end of the 6 months of treatment, residues of the lesions were imperceptible and new adenopathies or relapses were not detected during 4 years of follow up. The second case, a boy without family history of tuberculosis, presented more lesions. The signs of marked improvement were observed in the whole affected region one year after IFN gamma started. Their treatment was extended for almost 2 years, when the scars took the normal skin pigmentation. The cytokine was well tolerated; few febrile events were recorded, well-controlled with antipyretics. We can conclude that IFN gamma could be a new effective therapeutic alternative for the treatment of the suppurated lymphadenitis caused by BCG vaccination.

Adjuvant interferon gamma in patients with pulmonary atypical Mycobacteriosis: a randomized, double-blind, placebo-controlled study.

BACKGROUND: High antibiotic resistance is described in atypical Mycobacteriosis, mainly by Mycobacterium avium complex (MAC). METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in two hospitals to evaluate the effect of interferon (IFN) gamma as immunoadjuvant to chemotherapy on patients with atypical mycobacteria lung disease. Patients received placebo or 1 x 106 IU recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to daily oral azithromycin, ciprofloxacin, ethambutol and rifampin. Sputum samples collection for direct smear observation and culture as well as clinical and thorax radiography assessments were done during treatment and one year after. Cytokines and oxidative stress determinations were carried out in peripheral blood before and after treatment. RESULTS: Eighteen patients were included in the IFN group and 14 received placebo. Groups were homogeneous at entry; average age was 60 years, 75% men, 84% white; MAC infection prevailed (94%). At the end of treatment, 72% of patients treated with IFN gamma were evaluated as complete responders, but only 36% in the placebo group. The difference was maintained during follow-up. A more rapid complete response was obtained in the IFN group (5 months before), with a significantly earlier improvement in respiratory symptoms and pulmonary lesions reduction. Disease-related deaths were 35.7% of the patients in the placebo group and only 11.1% in the IFN group. Three patients in the IFN group normalized their globular sedimentation rate values. Although differences in bacteriology were not significant during the treatment period, some patients in the placebo group converted again to positive during follow-up. Significant increments in serum TGF-beta and advanced oxidation protein products were observed in the placebo group but not among IFN receiving patients. Treatments were well tolerated. Flu-like symptoms predominated in the IFN gamma group. No severe events were recorded. CONCLUSION: These data suggest that IFN gamma is useful and well tolerated as adjuvant therapy in patients with pulmonary atypical Mycobacteriosis, predominantly MAC. Further wider clinical trials are encouraged. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70900209.

Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: a parallel, randomized, double blind study.

BACKGROUND: Recombinant human erythropoietin (EPO) is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. METHODS: A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A), a newly developed product and Eprex (CILAG AG, Switzerland, formulation B), as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA) during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. RESULTS: Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively). The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8-1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their intensity. The more frequent events were pain at injection site (35.3%) and hypertension (29%). Additionally, further treatment of the patients with the study product yielded satisfactory increases in hemoglobin and hematocrit values. CONCLUSION: The formulations are comparable. The newly developed product should be acceptable for long-term application.

Bioequivalence of two recombinant granulocyte colony-stimulating factor formulations in healthy male volunteers.

To evaluate the equivalence of the pharmacokinetic, pharmacodynamic and safety properties of two recombinant G-CSF formulations in healthy male volunteers, a standard 2-way randomized crossover double-blind study, with a 3 week washout period, was conducted. A single 300 microg G-CSF dose was administered subcutaneously. Hebervital (Heber Biotec, Havana, formulation A) and Neupogen (Hoffmann-La Roche S.A, formulation B) were compared. Twenty-four healthy male volunteers were included. The serum G-CSF level was measured by enzyme immunoassay (EIA) during the first 36 h after administration. Absolute neutrophils (ANC), white blood cells (WBC) and CD34+ cells counts were the pharmacodynamic variables measured up to 120 h. Other clinical and laboratory determinations were used as safety criteria. The pharmacokinetic parameters for formulation A and B were very close to each other (i.e. AUC, 235.9 vs 270.0 ng.h/ml; C(max), 29.2 vs 33.4 ng/ml; T(max), 4.2 vs 4.7 h; half-life, 3.2 vs 2.8 h; CL, 260.9 vs 277.2 ml/h; V(d), 1.2 vs 1.1 l; and MRT, 7.58 vs 7.38 h). The confidence intervals for the means ratio of all these parameters were within or very close to the 0.8-1.25 acceptance range. The pharmacodynamics showed high similarity since ANC and WBC had the same profiles for both products and no differences were detected for the estimated parameters. The CD34+ cells count increments were evident for both formulations in a similar way as well. The treatments were well tolerated. Registered adverse events were similar; back/spine pain was the most frequent. According to the overall results these formulations could be considered as clinically comparable.

Adjuvant interferon gamma in patients with drug - resistant pulmonary tuberculosis: a pilot study.

BACKGROUND: Tuberculosis (TB) is increasing in the world and drug-resistant (DR) disease beckons new treatments. METHODS: To evaluate the action of interferon (IFN) gamma as immunoadjuvant to chemotherapy on pulmonary DR-TB patients, a pilot, open label clinical trial was carried out in the Cuban reference ward for the management of this disease. The eight subjects existing in the country at the moment received, as in-patients, 1 x 10(6) IU of recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to the indicated chemotherapy, according to their antibiograms and WHO guidelines. Sputum samples collection for direct smear observation and culture as well as routine clinical and thorax radiography assessments were done monthly. RESULTS: Sputum smears and cultures became negative for acid-fast-bacilli before three months of treatment in all patients. Lesion size was reduced at the end of 6 months treatment; the lesions disappeared in one case. Clinical improvement was also evident; body mass index increased in general. Interferon gamma was well tolerated. Few adverse events were registered, mostly mild; fever and arthralgias prevailed. CONCLUSIONS: These data suggest that IFN gamma is useful and well tolerated as adjunctive therapy in patients with DR-TB. Further controlled clinical trials are encouraged.

Bioequivalence of two recombinant interferon alpha-2b liquid formulations in healthy male volunteers.

OBJECTIVE: Interferon (IFN) alpha-2b is a protein with antiviral, antiproliferative and immunoregulatory properties that is approved for several clinical indications. A new liquid, albumin-free, IFNalpha-2b formulation has recently been developed. This study aimed to evaluate the equivalence of the pharmacokinetic, pharmacodynamic and safety properties of the new formulation with a reference one in healthy male volunteers. METHODS: A randomised, crossover, double-blind study with a 3-week washout period was performed in which Heberon Alfa R (formulation A) and Viraferon (formulation B) were compared. A single 20 x 10(6) IU IFNalpha-2b dose was administered subcutaneously to 14 apparently healthy male subjects. Serum IFN level was measured over 48 hours by enzyme immunoassay (EIA) and by antiviral activity titration. Clinical and laboratory variables were determined, as were pharmacodynamic and safety criteria. RESULTS: Groups were homogeneous with regard to all demographic and baseline variables. Pharmacokinetic comparison by EIA did not show differences between the formulations: area under the curve (AUC) 2572 versus 2561 ng x h/L, maximum plasma concentration (Cmax) 318 versus 354 ng/L, time to Cmax (tmax) 8.2 versus 8.5 h, elimination half-life (t(1/2)) 5.87 versus 6.08 h, terminal elimination rate (lambda) 0.122 versus 0.118 h(-1), and mean residence time (MRT) 10.9 versus 12.0 h for formulations A and B, respectively. The differences never reached 20%, which is the clinically significant threshold. The 90% confidence interval of the ratio between them was in all cases within the 0.8, 1.25 range. The two formulations were clinically equivalent with regard to serum IFN antiviral activity titration (0.8, 1.25 criterion) regarding their pharmacokinetic parameters. There were no significant differences with respect to the pharmacodynamic variables: serum beta2-microglobulin and temperature increase. Heart rate and blood pressure changes did not differ either. Both products provoked similar haematological count decreases and had similar safety profiles. The most frequent adverse reactions were fever, tachycardia, headache and arthralgias. CONCLUSION: The overall analysis strongly suggests the bioequivalence of these two products.