Lenalidomide in combination with intravenous rituximab (REVRI) in relapsed/refractory primary CNS lymphoma or primary intraocular lymphoma: a multicenter prospective 'proof of concept' phase II study of the French Oculo-Cerebral lymphoma (LOC) Network and the Lymphoma Study Association (LYSA)†.

BACKGROUND: Primary central nervous system lymphomas (PCNSLs) are mainly diffuse large B-cell lymphomas (DLBCLs) of the non-germinal center B-cell (non-GCB) subtype. This study aimed to determine the efficacy of rituximab plus lenalidomide (R2) in DLBCL-PCNSL. PATIENTS AND METHODS: Patients with refractory/relapsed (R/R) DLBCL-PCNSL or primary vitreoretinal lymphoma (PVRL) were included in this prospective phase II study. The induction treatment consisted of eight 28-day cycles of R2 (rituximab 375/m2 i.v. D1; lenalidomide 20 mg/day, D1-21 for cycle 1; and 25 mg/day, D1-21 for the subsequent cycles); in responding patients, the induction treatment was followed by a maintenance phase comprising 12 28-day cycles of lenalidomide alone (10 mg/day, D1-21). The primary end point was the overall response rate (ORR) at the end of induction (P0 = 10%; P1 = 30%). RESULTS: Fifty patients were included. Forty-five patients (PCNSL, N = 34; PVRL, N = 11) were assessable for response. The ORR at the end of induction was 35.6% (95% CI 21.9-51.2) in assessable patients and 32.0% (95% CI 21.9-51.2) in the intent-to-treat analysis, including 13 complete responses (CR)/unconfirmed CR (uCR; 29%) and 3 partial responses (PR; 7%). The best responses were 18 CR/uCR (40%) and 12 PR (27%) during the induction phase. The maintenance phase was started and completed by 18 and 5 patients, respectively. With a median follow-up of 19.2 months (range 1.5-31), the median progression-free survival (PFS) and overall survival (OS) were 7.8 months (95% CI 3.9-11.3) and 17.7 months (95% CI 12.9 to not reached), respectively. No unexpected toxicity was observed. The peripheral baseline CD4/CD8 ratio impacted PFS [median PFS = 9.5 months (95% CI, 8.1-14.8] for CD4/CD8 ≥ 1.6; median PFS = 2.8 months, [95% CI, 1.1-7.8) for CD4/CD8 < 1.6, P = 0.03). CONCLUSIONS: The R2 regimen showed significant activity in R/R PCNSL and PVRL patients. These results support assessments of the efficacy of R2 combined with methotrexate-based chemotherapy as a first-line treatment of PCNSL. CLINICAL TRIALS NUMBER: NCT01956695.

Extension of ustekinumab maintenance dosing interval in moderate-to-severe psoriasis: results of a phase IIIb, randomized, double-blinded, active-controlled, multicentre study (PSTELLAR).

BACKGROUND: Phase III studies showed that some patients maintained response for ≥ 6 months following ustekinumab discontinuation. OBJECTIVES: To assess clinical responses with extended ustekinumab maintenance dosing intervals. METHODS: Adults with moderate-to-severe plaque psoriasis received ustekinumab at weeks 0, 4 and 16 during open-label treatment. Patients achieving a week-28 Physician's Global Assessment (PGA) score of cleared/minimal (PGA = 0/1) were randomized 1 : 4 to group 1 [approved every 12 weeks (q12 wk) maintenance] or group 2 (q12-24 wk; response-based dosing determined by time to loss of PGA = 0/1). Key end points included the number of visits with PGA = 0/1 (primary end point) and ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) between weeks 88 and 112, and PGA/PASI responses between weeks 28 and 112. RESULTS: Overall, 378 patients achieved PGA = 0/1 at week 28 and were randomized to group 1 (n = 76) or group 2 (n = 302). Patients in group 1 had numerically greater mean numbers of visits with PGA = 0/1 than group 2 and also with PASI 75 from week 88 to 112. A higher proportion of patients in group 1 (55%) than group 2 (39%) had PGA = 0/1 at all seven visits from week 88 to 112. Maintenance of response was observed with dose-interval extension beyond q12 wk in a subset of patients. Extending the dosing interval did not affect antibody development or safety. CONCLUSIONS: Efficacy was better maintained among week-28 PGA responders randomized to continue q12 wk ustekinumab vs. extending maintenance dosing based on clinical response, although some patients maintained high levels of efficacy with up to q24 wk dosing.

Demography, baseline disease characteristics and treatment history of patients with psoriasis enrolled in a multicentre, prospective, disease-based registry (PSOLAR).

BACKGROUND: Psoriasis is associated with several comorbidities and behavioural risk factors. OBJECTIVES: To evaluate demographic and disease characteristics in patients enrolled in the Psoriasis Longitudinal Assessment and Registry (PSOLAR). METHODS: PSOLAR is a global, prospective, longitudinal, disease-based registry that includes a postmarketing commitment to evaluate safety in patients with psoriasis. Enrolled patients had to be receiving, or be eligible to receive, conventional systemic or biological agents. Demographic/disease characteristics, medical histories, lifestyle risk factors and previous treatments are collected at enrolment. Efficacy and safety data are collected every 6 months for 8 years, and data are extracted annually. Selected parameters are evaluated by age quartile using post hoc analyses. RESULTS: As of 23 August 2012, 11 900 patients were enrolled at 301 sites in North America, Europe and Latin America. Over half of the PSOLAR population (54·7%) is male, with a mean age of 48·6 years and mean body mass index of 30·9 kg m(-2) at enrolment. Mean duration of disease at enrolment was 17·5 years, and mean Physician's Global Assessment score was 2·0. Psoriatic arthritis (35·5%) and cardiovascular diseases (38·2%) were highly prevalent. Diabetes mellitus type II was reported in 11·4% of patients. Depression and anxiety were noted in 14·7% and 11·1% of patients, respectively; 79·0% reported any alcohol use and 56·7% reported smoking or a history of smoking. The occurrence of most comorbidities, including cardiovascular disease and risk factors, increased with age. CONCLUSIONS: In the PSOLAR population, multiple and age-appropriate comorbidities are associated with psoriasis and may affect the selection of psoriasis treatments.

Efficient preparation of human monoclonal antibody-secreting heterohybridomas using peripheral B lymphocytes cultured in the CD40 system.

The use of peripheral B lymphocytes in the successful preparation of human monoclonal antibodies by hybridoma technology is highly dependent on lymphocyte activation procedures. We studied the ability of peripheral human B lymphocytes cultured in vitro and activated through their CD40 antigen (CD40 system) (Banchereau et al., 1991) to form antibody-secreting heterohybridomas after fusion with murine X63Ag8.653 myeloma cells. The frequency of antibody-secreting heterohybridomas formation was greatly increased (15 times) by culture of B cells in the CD40 system. The CD40 system offers many advantages over other procedures of B lymphocyte activation representing a significant technological advance in the preparation of human monoclonal antibodies by standard hybridoma technology.

Use of hu-IgG-SCID mice to evaluate the in vivo stability of human monoclonal IgG antibodies.

Human and in vitro modified mAbs such as humanized rodent mAbs and immunotoxins are now considered for a variety of applications in humans. The adequate in vivo stability of these Ig preparations is not easily predicted from in vitro studies and may be essential for many therapeutic applications. In this study, we report the development and characterization of an in vivo model for testing this parameter using SCID mice containing a physiological concentration of human IgG (hu-IgG-SCID). The model was tested with several IgG1 and IgG3 human mAbs reacting with the human Rh(D) red cell antigen. It is known that human IgG have a shorter half-life in SCID mice than in humans. However, our results showed that the half-life of IgG3 mAbs (1.5 +/- 0.5 days) was much shorter than the one of IgG1 mAbs (5.8 +/- 1.4 days), indicating that the relative stability of IgG1 and IgG3 human mAbs in hu-IgG-SCID mice is similar to the one previously reported in humans (21 days vs. 7 days respectively). The IgG catabolism rate in humans is known to be inversely proportional to serum IgG concentrations. Accordingly, the dilution of the mAbs in a large excess (200-fold) of human IgG was found to be an important parameter of the hu-IgG-SCID mouse model since much longer (3-4-fold) mAb half-lives were obtained in the presence of a lower dose or in the absence of co-injected human IgG. This study show the usefulness of this animal model for the evaluation of human antibody stability in an in vivo environment.

Effect of xylitol consumption on the plaque-saliva distribution of mutans streptococci and the occurrence and long-term survival of xylitol-resistant strains.

Since the exposure of mutans streptococci to xylitol is known to select for xylitol-resistant (XR) natural mutants, the occurrence and long-term survival of such xylitol-resistant strains was evaluated in a cross-sectional sampling of participants of the Ylivieska xylitol study four years after the original two-year experimental period. Paraffin-stimulated whole saliva was first collected, and then plaque was collected and pooled. The salivary and dental plaque mutans streptococci were enumerated after growth on TSY20B agar. The proportion of XR strains was determined by autoradiography with 14C-xylitol. A strong and significant correlation (r = 0.645 and p = 0.005) between the number of mutans streptococci in saliva and in dental plaque was observed in non-consumers of xylitol. Such a correlation totally disappeared (r = 0.098 and p = 0.612) in xylitol-exposed consumers (habitual and former xylitol-consumers). The proportion of the salivary XR mutants (35%) in non-consumers (n = 16) was significantly lower than in the xylitol-exposed consumers (79%) (n = 27), (p = 0.0001) or in former consumers (75%) (n = 13), (p = 0.0008) or in the habitual consumers (83%) (n = 14), (p = 0.004). The proportion of XR mutants in dental plaque was, on the average, much lower than in the corresponding saliva. The proportion of XR in the plaque of xylitol non-consumers was half of that of the xylitol-exposed group, but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary Studies of in vitro and in vivo Effects of Misoprostol on Th-1 and Th-2 Cytokine Production.

Prostaglandins of the E series are known to suppress in vitro production of Th-1 cytokines such as interleukin-2 (IL-2) and interferon-gamma but have not been shown to suppress production of Th-2 cytokines such as IL-4 or IL-10. The present study used two new synthetic prostaglandin E(1) (PGE(1)) analogs with oral bioavailability, misoprostol (MP), and enisoprost (EP), to determine if these agents (1) exert suppressive effects in vitro on cytokine production by fresh unseparated mouse splenocytes and (2) are beneficial in vivo when used in conditions mediated by excessive Th-1 or Th-2 cytokine production. Preliminary in vitro studies demonstrated that both MP and EP can inhibit mitogen-stimulated Th-1 and Th-2 cytokine production in a dose-dependent fashion. Interestingly, at low doses, a stimulatory effect on interferon-gamma production was seen for both agents. In vivo studies tested the ability of parenteral administration of MP to alter outcome in the parent-into-F1 model of acute or chronic graft-vs-host disease (GVHD), entities thought to be mediated by excessive Th-1 or Th-2 cytokine production, respectively. Administration of MP to mice undergoing acute GVHD resulted in little detectable effect. However, in three independent experiments, MP administration in chronic GVHD mice consistently blocked GVHD-associated lymphoproliferation. In two of three experiments, GVHD-associated autoantibody production was significantly reduced. Variability between individual mice and between experiments suggests that dosing regimens and MP preparation are of critical importance. Nevertheless, these findings raise the possibility that MP may be of benefit in the treatment of human diseases characterized by excessive Th-2 cytokine production and humoral autoimmunity, for example, human lupus.

[Measurement of the quality of life in chronic hepatitis C: validation of a general index and specific index. First French results]. / Mesure de la qualité de vie chez les malades ayant une hépatite chronique virale C: validation d'un indicateur général et d'un indicateur spécifique.

OBJECTIVES: To report the validation of 2 questionnaires of quality of life in chronic hepatitis C and the first results in 100 patients. METHODS: The questionnaire included 118 items and took 30 to 45 minutes to answer. It included a general index, the Nottingham Health Profile, with 38 items in 6 themes (physical mobility, social isolation, emotional reactions, pain, sleep and energy) and a specific index, the Montpellier Specific Index, with 80 items in 7 themes: symptoms, food, alcohol and tobacco, work, relations with other people, perception of disease. RESULTS: The questionnaires were self-administered to the 100 first patients with chronic hepatitis C without cirrhosis before treatment; 55 men, 45 women, average age 40 year-old, median Knodell's score 8 and median METAVIR score A2 F1. Reduction in the quality of life was frequent and was not highly correlated with biological, virological and histological parameters; it was associated with psychological disorders, reduced sexuality and apprehension of the future. CONCLUSION: This study showed the feasibility, validation, sensitivity and agreement of a quality of life questionnaire, which included a general index and a specific index of chronic hepatitis C in France. These initial results must be confirmed in studies during antiviral treatment of patients.

[A rapid method for continuous flow measurement of cholesterol contained in high density lipoproteins (HDL) (author's transl)]. / Méthode de dosage rapide du cholestérol des lipoprotéines de haute densité (HDL) en flux continu.

The authors utilized a reagent containing concanavalin A, a vegetal lecithin, to selectively precipitate lipoproteins containing apoprotein B, a component of VLDL, LDL, and Lp (a) which are well known for their atherogenic risk. During this precipitation "true" high density lipoproteins remain in solution. HDL cholesterol determination which constitutes an indirect indication of HDL activity or concentrations is performed by an enzymatic method using an automated continuous flow technique carried out on an Auto Analyzer II (Technicon Corp.). This rapid, easy determination obtains results comparable to other methods, particularly those chosen by the Société Française de Biologie Clinique (French Society of Clinical Biology). This technique should permit all laboratories to confirm an atherogenic index.

Structural abnormalities in patients with insular/peri-insular epilepsy: spectrum, frequency, and pharmacoresistance.

SUMMARY: Between 2002 and 2010, a total of 48 patients were seen at our epilepsy clinic with insular/peri-insular cortex epilepsy. Review of their MR imaging scans revealed a neoplastic lesion in 27% of patients, a malformation of cortical development in 21%, a vascular malformation in 19%, and atrophy/gliosis from an acquired insult in 17%. MR imaging results were normal in 4 patients. Other miscellaneous findings included a case of Rasmussen encephalitis, a nonspecific insular millimetric T2 signal abnormality, a neuroepithelial cyst, and hippocampal sclerosis without MR imaging evidence of dual insular pathologic features (despite depth electrode-proven insular seizures). Refractoriness to antiepileptic drug treatment was present in 56% of patients: 100% for patients with malformations of cortical development (1.0; 95% CI, 0.72-1.0), 50.0% (0.5; 95% CI, 0.21-0.78) in the presence of atrophy/gliosis from acquired insults, 39% (0.39; 95% CI, 0.14-0.68) for neoplastic lesions, and 22.2% (0.22; 95% CI, 0.06-0.55) for vascular malformations.

Insular ischemic stroke: clinical presentation and outcome.

BACKGROUND: The insula is a small but complex structure located in the depth of the sylvian fissure, covered by the frontal, parietal and temporal operculum. Ischemic strokes limited to the insula are rare and have not been well studied. Our objective is to better define the clinical presentation and outcome of insular ischemic strokes (IIS). METHODS: We reviewed the institutional prospective, consecutive stroke database from two centers to identify patients with IIS seen between 2008 and 2010. We also searched the Medline database using the keywords insula(r), infarction and stroke to identify previously published IIS cases confirmed by MRI. Minimal extension to an adjacent operculum or subinsular area was accepted. Clinicoradiological correlation was performed by distinguishing IIS involving the anterior (AIC) or posterior insular cortex (PIC). We collected clinical, demographic and radiological data. The outcome was determined using the modified Rankin Scale (mRS). RESULTS: We identified 7 patients from our institutions and 16 previously published cases of IIS. Infarcts were limited to the AIC (n = 4) or the PIC (n = 12) or affected both (n = 7). The five most frequent symptoms were somatosensory deficits (n = 10), aphasia (n = 10), dysarthria (n = 10), a vestibular-like syndrome (n = 8) and motor deficits (n = 6). A significant correlation was found between involvement of the PIC and somatosensory manifestations (p = 0.04). No other statistically significant associations were found. IIS presentation resembled a partial anterior circulation infarct (n = 9), a lacunar infarct (n = 2) or a posterior circulation infarct (n = 2). However, most cases presented findings that did not fit with these classical patterns (n = 10). At the 6 month follow up, mRS was 0 in 8/23 (35%) patients, 1-2 in 7/23 (30%) and unknown in 8/23 (35%). CONCLUSIONS: IIS presentation is variable. Due to the confluence of functions in a restricted region, it results in multimodal deficits. It should be suspected when vestibular-like or motor but especially somatosensory, speech or language disturbances are combined in the same patient. The outcome of IIS is often favorable. Larger prospective studies are needed to better define the clinical presentation and outcome of IIS.

A matrix-assisted laser desorption time-of-flight mass spectrometer based on a 600 ps, 1.2 mJ nitrogen laser.

The design and performance of a short-pulse UV laser desorption time-of-flight mass spectrometer is described. The instrument combines the advantages of a 600 ps, 337 nm pulsed nitrogen laser with a compact, high-voltage extraction linear time-of-flight analyzer. A number of peptides and proteins have been analyzed to demonstrate sensitivity, high mass range, resolution and mixture analysis.

[Polygraphic study during hyperpnea tests in elderly subjects (author's transl)]. / Etude polygraphique de l'épreuve d'hyperpnée chez le sujet agé.

The incidence of age on the frequency of post-hyperventilation apnea was studied in two randomly chosen distinct populations. The hyperpnea and ventilatory response were recorded during a standard E.E.G. tracing in 1 060 subjects by a thermistor and in 100 other subjects by pneumotachography and capnography. Post-hyperventilation frequency was determined for the two populations taken overall and then for subjects under and over 60 years of age. The results were compared with demographic data (sex, excess bodyweight coefficient, illness), and experimental conditions (alertness, recording technique). In the second population the mean ventilation per minute rate was calculated during a reference rest period and two successive hyperventilation tests. The frequency of post-hyperventilation apnea is higher before 60 years of age in the absence of variations in alertness and/or associated supramedullary lesions. Ventilatory response under 60 years of age is seen as a prolonged phase of hypoventilation. After 60 years of age, in the absence of apnea, ventilation returns immediately to its reference value, while in the presence of apnea the hypoventilatory phase observed is of brief duration and delayed. These results are discussed and compared to those in the published literature.

Rate of degradation of [alpha]- and [beta]-oligodeoxynucleotides in Xenopus oocytes. Implications for anti-messenger strategies.

End-labelled oligodeoxynucleotides were injected into Xenopus laevis oocytes and their degradation products were analysed by high-performance ion-exchange liquid chromatography after various times of incubation. The oligonucleotides were synthesised with either the natural [beta] anomers or the synthetic [alpha] anomers of deoxynucleotide units. Oligo-[beta] deoxynucleotides are short-lived inside oocytes (half-life approximately equal to 10 min). Covalent attachment of an intercalating agent to the 3'-phosphate and of a methylthiophosphate group at the 5'-end protects oligodeoxynucleotides against 3'- and 5'-exonucleases, respectively. The half-life of such substituted oligodeoxynucleotides is increased to 40 minutes. Oligo-[alpha]-deoxynucleotides are quite resistant to both endo and exonucleases inside Xenopus oocytes. After 8 hours only 40% of a 16-mer oligo-[alpha]-deoxynucleotide were hydrolysed. The rapid degradation of oligo-[beta]-deoxynucleotides suggests that efficient inhibition of translation in Xenopus oocytes involves an RNase H-induced hydrolysis of mRNAs hybridized to oligo-[beta]-deoxynucleotides.

Evidence for restricted diversity of antigen-specific human antibodies in immunized hu-PBL-SCID mice.

Previous studies have revealed that specific human humoral immune responses could be produced in immunized SCID mice after engraftment of human lymphocytes (hu-PBL-SCID). On the other hand, the engrafted repertoire of B cell clones is known to be skewed in hu-PBL-SCID with the corresponding production of only a limited set of major human antibodies. In this work, we have analyzed the diversity of tetanus toxoid-specific human antibodies produced in immunized hu-PBL-SCID mice in comparison with the total serum antibody population using zone electrophoresis followed by blotting. The results showed that the diversity of tetanus toxoid-specific antibody population was more restricted than that of the total human antibody population, with some animal sera containing a single band of tetanus toxoid-specific antibody molecule, in clear contrast to the polyclonal response of the PBL donor. Absorption experiments showed tetanus toxoid-specific antibodies could account for a significant proportion (up to 10%) of the total human antibodies present in hu-PBL-SCID mouse sera. The inability to expand a high number of different antigen-specific B cell clones in immunized hu-PBL-SCID mice represents an important intrinsic limitation of this animal model which may be caused by defects in T cell help.

Effects of various substances on two types of inflammatory reaction in animals.

The effects of 16 substances, including non-steroidal anti-inflammatory agents, a corticoid, phenols, immunomodulators and gold salts, were studied using two types of acute inflammatory reaction, a non-specific reaction (carrageenan-induced oedema) and an immune reaction (reversed passive Arthus reaction in the rat or active Arthus reaction in the mouse). Results revealed that the active Arthus model appears to be more selective than the passive reversed Arthus model, which is itself less sensitive than the carrageenan model. The active Arthus reaction might be useful for secondary screening of molecules that act on mechanisms modulating the intervention of complement and the various functions of polymorphonuclear leucocytes, and the passive Arthus reaction appears to be more suitable for preliminary screening. The activities of the different substances studied are discussed in terms of their modes of action and toxicity.