Characterization and Reactivity Studies of Mononuclear Tetrahedral Copper(II)-Halide Complexes.

Structures, physicochemical properties, and reactivity of the whole series of copper(II)-halide complexes (1X; X = F, Cl, Br, and I) were examined using a TMG3tach tridentate supporting ligand consisting of cis,cis-1,3,5-triaminocyclohexane (tach) and N,N,N',N'-tetramethylguanidine (TMG). The tach ligand framework with the bulky and strongly electron-donating TMG substituents enforces the copper(II) complexes to take a tetrahedral geometry, as inferred from the electron paramagnetic resonance (EPR) spectra, exhibiting relatively large gz and small Az values. The electronic absorption spectra of 1X agreed with the simulation spectra obtained by time-dependent density functional theory (TD-DFT) calculations on a slightly distorted tetrahedral geometry. 1I and 1Br gradually decomposed to generate the corresponding copper(I) complex and halide radical X•, and in the case of 1Br, intramolecular hydroxylation of a methyl group of the TMG substituent took place under aerobic conditions, which may be caused by the reaction of the generated copper(I) complex and dioxygen (O2), generating a reactive oxygen species. 1X except 1I showed hydrogen atom abstraction (HAA) reactivity toward 1,4-cyclohexadiene (CHD), where 1F exhibited the highest reactivity with a second-order rate constant as 1.4 × 10-3 M-1 s-1 at 25 °C. Such an HAA reactivity can be attributed to the higher basicity of F- and/or large bond dissociation free energy of conjugate acid H-F as well as the unstable copper(II) electronic state in the tetrahedral geometry.

Revisiting Alkane Hydroxylation with m-CPBA (m-Chloroperbenzoic Acid) Catalyzed by Nickel(II) Complexes.

Mechanistic studies are performed on the alkane hydroxylation with m-CPBA (m-chloroperbenzoic acid) catalyzed by nickel(II) complexes, NiII (L). In the oxidation of cycloalkanes, NiII (TPA) acts as an efficient catalyst with a high yield and a high alcohol selectivity. In the oxidation of adamantane, the tertiary carbon is predominantly oxidized. The reaction rate shows first-order dependence on [substrate] and [NiII (L)] but is independent on [m-CPBA]; vobs =k2 [substrate][NiII (L)]. The reaction exhibited a relatively large kinetic deuterium isotope effect (KIE) of 6.7, demonstrating that the hydrogen atom abstraction is involved in the rate-limiting step of the catalytic cycle. Furthermore, NiII (L) supported by related tetradentate ligands exhibit apparently different catalytic activity, suggesting contribution of the NiII (L) in the catalytic cycle. Based on the kinetic analysis and the significant effects of O2 and CCl4 on the product distribution pattern, possible contributions of (L)NiII -O. and the aroyloxyl radical as the reactive oxidants are discussed.

Hydroxylation of Unactivated C(sp3)-H Bonds with m-Chloroperbenzoic Acid Catalyzed by an Iron(III) Complex Supported by a Trianionic Planar Tetradentate Ligand.

Hydroxylation of cyclohexane with m-chloroperbenzoic acid was examined in the presence of an iron(III) complex supported by a trianionic planar tetradentate ligand. The present reaction system shows a high turnover number of 2750 with a high product selectivity of alcohol (93%). The turnover frequency was 0.51 s-1, and the second-order rate constant (k) for the C-H bond activation of cyclohexane was 1.08 M-1 s-1, which is one of the highest values among the iron complexes in the oxidation of cyclohexane so far reported. The present catalytic system can be adapted to the hydroxylation of substrates having only primary C-H bonds such as 2,2,3,3-tetramethylbutane as well as gaseous alkanes such as butane, propane, and ethane. The involvement of an iron(III) acyl peroxido complex as the reactive species was suggested by spectroscopic measurements of the reaction solution.

Controlling the Reactivity of Copper(II) Acylperoxide Complexes.

The redox state of the metallomonooxygenases is finely tuned by imposing specific coordination environments on the metal center to reduce the activation energy for the generation of active-oxygen species and subsequent substrate oxygenation reactions. In this study, copper(II) complexes supported by a series of linear tetradentate ligands consisting of a rigid 6-, 7-, or 8-membered cyclic diamine with two pyridylmethyl (-CH2Py) side arms (L6Pym2, L7Pym2, and L8Pym2) are employed to examine the effects of the coordination environment on the reactivity of their acylperoxide adduct complexes. The UV-vis and electron paramagnetic resonance spectroscopic data indicate that the ligand-field splitting between the dx2-y2 and dz2 orbitals of the starting copper(II) complexes increase with an increase of the ring size of the diamine moiety (L6Pym2 → L7Pym2 → L8Pym2). In the reaction of these copper(II) complexes with m-chloroperbenzoic acid (m-CPBA), the L6Pym2 complex gives a stable m-CPBA adduct complex, whereas the L7Pym2 and L8Pym2 complexes are immediately converted to the corresponding m-chlorobenzoic acid (m-CBA) adducts, indicating that the reactivity of the copper(II) acylperoxide complexes largely depends on the coordination environment induced by the supporting ligands. Density functional theory (DFT) calculations on the m-CPBA adduct complexes show that the ligand-field-splitting energy increases with an increase of the ring size of the diamine moiety, as in the case of the starting copper(II) complexes, which enhances the reactivity of the m-CPBA adduct complexes. The reasons for such different reactivities of the m-CPBA adduct complexes are evaluated by using DFT calculations.

Tin(II)-Nitrene Radical Complexes Formed by Electron Transfer from Redox-Active Ligand to Organic Azides and Their Reactivity in C(sp3)-H Activation.

A tin(II) complex coordinated by a sterically demanding o-phenylenediamido ligand is synthesized. The ligand is redox-active to reach a tin(II) complex with the diiminobenzosemiquinone radial anion in the oxidation by AgPF6. The tin(II) complex reacts with a series of nosylazides (x-NO2C6H4-SO2-N3; x = o, m, or p) at -30 °C to yield the corresponding nitrene radical bound tin(II) complexes. The nitrene radical complexes exhibit C(sp3)-H activation and amination reactivity.

Characterization and Reactivity of a Tetrahedral Copper(II) Alkylperoxido Complex.

A tetrahedral CuII alkylperoxido complex [CuII (TMG3 tach)(OOCm)]+ (1OOCm ) (TMG3 tach={2,2',2''-[(1s,3s,5s)-cyclohexane-1,3,5-triyl]tris-(1,1,3,3-tetramethyl guanidine)}, OOCm=cumyl peroxide) is prepared and characterized by UV/Vis, cold-spray ionization mass spectroscopy (CSI-MS), resonance Raman, and EPR spectroscopic methods. Product analysis of the self-decomposition reaction of 1OOCm in acetonitrile (MeCN) indicates that the reaction involves O-O bond homolytic cleavage of the peroxide moiety with concomitant C-H bond activation of the solvent molecule. When an external substrate such as 1,4-cyclohexadiene (CHD) is added, the O-O bond homolysis leads to C-H activation of the substrate. Furthermore, the reaction of 1OOCm with 2,6-di-tert-butylphenol derivatives produces the corresponding phenoxyl radical species (ArO. ) together with a CuI complex through a concerted proton-electron transfer (CPET) mechanism. Details of the reaction mechanisms are explored by DFT calculations.

Noninnocent Ligand in Rhodium(III)-Complex-Catalyzed C-H Bond Amination with Tosyl Azide.

Six-coordinate rhodium(III) complexes coordinated by a planar trianionic ligand (L3-) are synthesized. One of the axial positions is occupied by chloride (Cl-), bromide (Br-), or iodide (I-), and another axial position is coordinated by a solvent molecule such as acetonitrile (AN), water (H2O), tetrahydrofuran (THF), or pyridine (PY) to complete an octahedral rhodium(III) center; [RhIII(L3-)(X)(Y)]- (1X/Y; X = Cl-, Br-, or I-, Y = AN, H2O, THF, or PY). Coordination of the AN, H2O, and THF ligands to the metal center is rather weak, so that these solvent molecules are easily replaced by PY to give [RhIII(L3-)(Cl)(PY)]-. In the electrochemical measurements, all complexes have two reversible redox couples based on the ligand-centered oxidation L3- to L•2- and to L-, as reflected by the very similar redox potentials regardless of the different axial ligands. The rhodium(III) complexes catalyze C-H bond amination of xanthene with tosyl azide (TsN3). Because the yields of the aminated product are nearly the same among the complexes, replacement of the axial solvent ligands with TsN3 readily occurs to give a nitrene-radical-bound rhodium(III) complex, [RhIII(L•2-)(N•Ts)(X)]-, as an active oxidant, which is generated by one-electron transfer from the trianionic L3- to the nitrene nitrogen atom. Generation of such a diradical intermediate was substantiated by the direct reaction of 1Cl/AN with TsN3 in the absence of the substrate (xanthene). In this case, a rhodium(III) iminosemiquinone complex, 2, was generated by the intramolecular reaction between the nitrene-radical moiety and the radical moiety of the ligand L•2-.

A Well-Defined Osmium-Cupin Complex: Hyperstable Artificial Osmium Peroxygenase.

Thermally stable TM1459 cupin superfamily protein from Thermotoga maritima was repurposed as an osmium (Os) peroxygenase by metal-substitution strategy employing the metal-binding promiscuity. This novel artificial metalloenzyme bears a datively bound Os ion supported by the 4-histidine motif. The well-defined Os center is responsible for not only the catalytic activity but also the thermodynamic stability of the protein folding, leading to the robust biocatalyst (Tm ≈ 120 °C). The spectroscopic analysis and atomic resolution X-ray crystal structures of Os-bound TM1459 revealed two types of donor sets to Os center with octahedral coordination geometry. One includes trans-dioxide, OH, and mer-three histidine imidazoles (O3N3 donor set), whereas another one has four histidine imidazoles plus OH and water molecule in a cis position (O2N4 donor set). The Os-bound TM1459 having the latter donor set (O2N4 donor set) was evaluated as a peroxygenase, which was able to catalyze cis-dihydroxylation of several alkenes efficiently. With the low catalyst loading (0.01% mol), up to 9100 turnover number was achieved for the dihydroxylation of 2-methoxy-6-vinyl-naphthalene (50 mM) using an equivalent of H2O2 as oxidant at 70 °C for 12 h. When octene isomers were dihydroxylated in a preparative scale for 5 h (2% mol cat.), the terminal alkene octene isomers was converted to the corresponding diols in a higher yield as compared with the internal alkenes. The result indicates that the protein scaffold can control the regioselectivity by the steric hindrance. This protein scaffold enhances the efficiency of the reaction by suppressing disproportionation of H2O2 on Os reaction center. Moreover, upon a simple site-directed mutagenesis, the catalytic activity was enhanced by about 3-fold, indicating that Os-TM1459 is evolvable nascent osmium peroxygenase.

Tetrahedral Copper(II) Complexes with a Labile Coordination Site Supported by a Tris-tetramethylguanidinato Ligand.

A new tridentate N3 ligand (TMG3tach) consisting of cis,cis-1,3,5-triaminocyclohexane (tach) and three N,N,N',N'-tetramethylguanidino (TMG) groups has been developed to prepare copper complexes with a tetrahedral geometry and a labile coordination site. Treatment of the ligand with CuIIX2 (X = Cl and Br) gave copper(II)-halide complexes, [CuII(TMG3tach)Cl]+ (2Cl) and [CuII(TMG3tach)Br]+ (2Br), the structures of which have been determined by X-ray crystallographic analysis. The complexes exhibit a four-coordinate structure with C3v symmetry, where the labile halide ligand (X) occupies a position on the trigonal axis. 2Br was converted to a methoxido-copper(II) complex [CuII(TMG3tach)(OMe)](OTf) (2OMe), also having a similar four-coordinate geometry, by treating it with an equimolar amount of tetrabutylammonium hydroxide in methanol. The methoxido-complex 2OMe was further converted to the corresponding phenolato-copper(II) (2OAr) and thiophenolato-copper(II) (2SAr) complexes by ligand exchange reactions with the neutral phenol and thiophenol derivatives, respectively. The electronic structures of the copper(II) complexes with different axial ligands are discussed on the basis of EPR spectroscopy and DFT calculations.

Redox-Triggered Helicity Inversion in Chiral Cobalt Complexes in Combination with H(+) and NO3(-) Stimuli.

Three chiral ligands with variable denticity, H2L2-H2L4, conjugated by N,N'-ethylenebis[N-methyl-(S)-alanine] and an ortho-heterosubstituted aromatic amine, were newly synthesized as analogues of previously reported H2L1. Four contracted-Λoxo cobalt(III) complexes [Co(L)](+) with left-handed helical structure of Λ4Δ2 configuration were prepared by one-electron oxidation of the corresponding contracted-Λred cobalt(II) complexes [Co(L)], which were generated from chiral ligands and Co(ClO4)2·6H2O or Co(CF3SO3)2·5.2H2O in the presence of an organic base. Although the prepared cobalt(III) complexes were very inert and kinetically stable against protonation and NO3(-) complexation, cobalt(III) reduction in the presence of CF3SO3H and/or Bu4NNO3 allowed immediate changing of their three-dimensional structures from the contracted-Λoxo form to the extended-Λ [Co(H2L)Y2](n+) (Y = solvent and/or anion, n = 0-2) form with left-handed helicity or to the extended-Δ [Co(H2L)(NO3)](+) form with right-handed helicity via N- to O-amide coordination switching. Both extended forms were contracted to the original Λoxo form by oxidation of the cobalt(II) center in the presence of an organic base. Thus, redox reactions triggered dynamic helicity inversion of the chiral cobalt complexes, via multiple molecular motions consisting of relaxation/compression, extension/contraction, and helicity inversion motions in combination with deprotonation/protonation of amide linkages and NO3(-) anion complexation.

A Model for the Active-Site Formation Process in DMSO Reductase Family Molybdenum Enzymes Involving Oxido-Alcoholato and Oxido-Thiolato Molybdenum(VI) Core Structures.

New bis(ene-1,2-dithiolato)-oxido-alcoholato molybdenum(VI) and -oxido-thiolato molybdenum(VI) anionic complexes, denoted as [Mo(VI)O(ER)L2](-) (E = O, S; L = dimethoxycarboxylate-1,2-ethylenedithiolate), were obtained from the reaction of the corresponding dioxido-molybdenum(VI) precursor complex with either an alcohol or a thiol in the presence of an organic acid (e.g., 10-camphorsulfonic acid) at low temperature. The [Mo(VI)O(ER)L2](-) complexes were isolated and characterized, and the structure of [Mo(VI)O(OEt)L2](-) was determined by X-ray crystallography. The Mo(VI) center in [Mo(VI)O(OEt)L2](-) exhibits a distorted octahedral geometry with the two ene-1,2-dithiolate ligands being symmetry inequivalent. The computed structure of [Mo(VI)O(SR)L2](-) is essentially identical to that of [Mo(VI)O(OR)L2](-). The electronic structures of the resulting molybdenum(VI) complexes were evaluated using electronic absorption spectroscopy and bonding calculations. The nature of the distorted O(h) geometry in these [Mo(VI)O(EEt)L2](-) complexes results in a lowest unoccupied molecular orbital wave function that possesses strong π* interactions between the Mo(d(xy)) orbital and the cis S(p(z)) orbital localized on one sulfur donor from a single ene-1,2-dithiolate ligand. The presence of a covalent Mo-S(dithiolene) bonding interaction in these monooxido Mo(VI) compounds contributes to their low-energy ligand-to-metal charge transfer transitions. A second important d-p π bonding interaction derives from the ∼180° O(oxo)-Mo-E-C dihedral angle involving the alcoholate and thiolate donors, and this contributes to ancillary ligand contributions to the electronic structure of these species. The formation of [Mo(VI)O(OEt)L2](-) and [Mo(VI)O(SEt)L2](-) from the dioxidomolybdenum(VI) precursor may be regarded as a model for the active-site formation process that occurs in the dimethyl sulfoxide reductase family of pyranopterin molybdenum enzymes.

Direct hydroxylation of benzene to phenol using hydrogen peroxide catalyzed by nickel complexes supported by pyridylalkylamine ligands.

Selective hydroxylation of benzene to phenol has been achieved using H2O2 in the presence of a catalytic amount of the nickel complex [Ni(II)(tepa)](2+) (2) (tepa = tris[2-(pyridin-2-yl)ethyl]amine) at 60 °C. The maximum yield of phenol was 21% based on benzene without the formation of quinone or diphenol. In an endurance test of the catalyst, complex 2 showed a turnover number (TON) of 749, which is the highest value reported to date for molecular catalysts in benzene hydroxylation with H2O2. When toluene was employed as a substrate instead of benzene, cresol was obtained as the major product with 90% selectivity. When H2(18)O2 was utilized as the oxidant, (18)O-labeled phenol was predominantly obtained. The reaction rate for fully deuterated benzene was nearly identical to that of benzene (kinetic isotope effect = 1.0). On the basis of these results, the reaction mechanism is discussed.

Generation, Characterization, and Reactivity of a Cu(II)-Alkylperoxide/Anilino Radical Complex: Insight into the O-O Bond Cleavage Mechanism.

The reaction of [Cu(I)(TIPT3tren) (CH3CN)]ClO4 (1) and cumene hydroperoxide (C6H5C(CH3)2OOH, ROOH) at -60 °C in CH2Cl2 gave a Cu(II)-alkylperoxide/anilino radical complex 2, the formation of which was confirmed by UV-vis, resonance Raman, EPR, and CSI-mass spectroscopy. The mechanism of formation of 2, as well as its reactivity, has been explored.

cis-1,2-Aminohydroxylation of Alkenes Involving a Catalytic Cycle of Osmium(III) and Osmium(V) Centers: Os(V)(O)(NHTs) Active Oxidant with a Macrocyclic Tetradentate Ligand.

Catalytic activity of [Os(III)(OH)(H2O)(L-N4Me2)](PF6)2 (1: L-N4Me2 = N,N'-dimethyl-2,11-diaza-[3,3](2,6)pyridinophane) in 1,2-cis-aminohydroxylation of alkenes with sodium N-chloro-4-methylbenzenesulfonamide (chloramine-T) is explored. Simple alkenes as well as those containing several types of substituents are converted to the corresponding 1,2-aminoalcohols in modest to high yields. The aminoalcohol products have exclusively cis conformation with respect to the introduced -OH and -NHTs groups. The spectroscopic measurements including cold mass spectroscopic study of the reaction product of complex 1 and chloromine-T as well as density functional theory (DFT) calculations indicate that an oxido-aminato-osmium(V) species [Os(V)(O)(NHTs)(L-N4Me2)](PF6)2 (2) is an active oxidant for the aminohydroxylation. The DFT calculations further indicate that the reaction involves a [3 + 2] cycloaddition between 2 and alkene, and the regioselectivity in the aminohydroxylation of unsymmetrical alkenes is determined by the orientation that bears less steric hindrance from the tosylamino group, which leads to the energetically more preferred product isomer.

Inhibitory effects of French pine bark extract, Pycnogenol®, on alveolar bone resorption and on the osteoclast differentiation.

Pycnogenol(®) (PYC) is a standardized bark extract from French maritime pine (Pinus pinaster Aiton). We examined the inhibitory effects of PYC on alveolar bone resorption, which is a characteristic feature of periodontitis, induced by Porphyromonas gingivalis (P. gingivalis) and osteoclast differentiation. In rat periodontitis model, rats were divided into four groups: group A served as the non-infected control, group B was infected orally with P. gingivalis ATCC 33277, group C was administered PYC in the diet (0.025%: w/w), and group D was infected with P. gingivalis and administered PYC. Administration of PYC along with P. gingivalis infection significantly reduced alveolar bone resorption. Treatment of P. gingivalis with 1 µg/ml PYC reduced the number of viable bacterial cells. Addition of PYC to epithelial cells inhibited adhesion and invasion by P. gingivalis. The effect of PYC on osteoclast formation was confirmed by tartrate-resistant acid phosphatase staining. PYC treatment significantly inhibited osteoclast formation. Addition of PYC (1-100 µg/ml) to purified osteoclasts culture induced cell apoptosis. These results suggest that PYC may prevent alveolar bone resorption through its antibacterial activity against P. gingivalis and by suppressing osteoclastogenesis. Therefore, PYC may be useful as a therapeutic and preventative agent for bone diseases such as periodontitis.

Geometric control of nuclearity in copper(I)/dioxygen chemistry.

Copper(I) complexes supported by a series of N3-tridentate ligands bearing a rigid cyclic diamine framework such as 1,5-diazacyclooctane (L8, eight-membered ring), 1,4-diazacycloheptane (L7, seven-membered ring), or 1,4-diazacyclohexane (L6, six-membered ring) with a common 2-(2-pyridyl)ethyl side arm were synthesized and their reactivity toward O2 were compared. The copper(I) complex of L8 preferentially provided a mononuclear copper(II) end-on superoxide complex S as reported previously [Itoh, S., et al. J. Am. Chem. Soc. 2009, 131, 2788-2789], whereas a copper(I) complex of L7 gave a bis(µ-oxido)dicopper(III) complex O at a low temperature (-85 °C) in acetone. On the other hand, no such active-oxygen complex was detected in the oxygenation reaction of the copper(I) complex of L6 under the same conditions. In addition, O2-reactivity of the copper(I) complex supported by an acyclic version of the tridentate ligand (LA, PyCH2CH2N(CH3)CH2CH2CH2N(CH3)2; Py = 2-pyridyl) was examined to obtain a mixture of a (µ-η(2):η(2)-peroxido)dicopper(II) complex (S)P and a bis(µ-oxido)dicopper(III) complex O. Careful inspection of the crystal structures of copper(I) and copper(II) complexes and the redox potentials of copper(I) complexes has revealed important geometric effects of the supporting ligands on controlling nuclearity of the generated copper active-oxygen complexes.

Redox chemistry of nickel(II) complexes supported by a series of noninnocent ß-diketiminate ligands.

Nickel complexes of a series of ß-diketiminate ligands ((R)L(-), deprotonated form of 2-substituted N-[3-(phenylamino)allylidene]aniline derivatives (R)LH, R = Me, H, Br, CN, and NO2) have been synthesized and structurally characterized. One-electron oxidation of the neutral complexes [Ni(II)((R)L(-))2] by AgSbF6 or [Ru(III)(bpy)3](PF6)3 (bpy = 2,2'-bipyridine) gave the corresponding metastable cationic complexes, which exhibit an EPR spectrum due to a doublet species (S = 1/2) and a characteristic absorption band in near IR region ascribable to a ligand-to-ligand intervalence charge-transfer (LLIVCT) transition. DFT calculations have indicated that the divalent oxidation state of nickel ion (Ni(II)) is retained, whereas one of the ß-diketiminate ligands is oxidized to give formally a mixed-valence complex, [Ni(II)((R)L(-))((R)L(•))](+). Thus, the doublet spin state of the oxidized cationic complex can be explained by taking account of the antiferromagnetic interaction between the high-spin nickel(II) ion (S = 1) and the organic radical (S = 1/2) of supporting ligand. A single-crystal structure of one of the cationic complexes (R = H) has been successfully determined to show that both ligands in the cationic complex are structurally equivalent. On the basis of theoretical analysis of the LLIVCT band and DFT calculations as well as the crystal structure, the mixed-valence complexes have been assigned to Robin-Day class III species, where the radical spin is equally delocalized between the two ligands to give the cationic complex, which is best described as [Ni(II)((R)L(0.5•-))2](+). One-electron reduction of the neutral complexes with decamethylcobaltocene gave the anionic complexes when the ligand has the electron-withdrawing substituent (R = CN, NO2, Br). The generated anionic complexes exhibited EPR spectra due to a doublet species (S = 1/2) but showed no LLIVCT band in the near-IR region. Thus, the reduced complexes are best described as the d(9) nickel(I) complexes supported by two anionic ß-diketiminate ligands, [Ni(I)((R)L(-))2](-). This conclusion was also supported by DFT calculations. Substituent effects on the electronic structures of the three oxidation states (neutral, cationic, and anionic) of the complexes are systematically evaluated on the basis of DFT calculations.

Real-World Case Series of Efgartigimod for Japanese Generalized Myasthenia Gravis: Well-Tailored Treatment Cycle Intervals Contribute to Sustained Symptom Control.

INTRODUCTION: Myasthenia gravis (MG), an immune disorder affecting nerve-muscle transmission, often necessitates tailored therapies to alleviate longitudinal symptom fluctuations. Here, we aimed to examine and compare the treatment cycle intervals and efficacy of efgartigimod in four patients. This case series mainly offers insights into personalized treatment cycle intervals and the efficacy of efgartigimod for patients with MG in our facility in Japan. METHODS: We retrospectively analyzed four patients with MG (2 patients with early-onset, 1 with late-onset, and 1 with seronegative MG, mainly managed with oral immunosuppressants as prior treatments) who completed four or more cycles of efgartigimod treatment from January 2022 to September 2023. We focused on changes in serum immunoglobulin (IgG) level, acetylcholine receptor antibody (AChR-Ab) titer, and quantitative MG (QMG) score. RESULTS: Efgartigimod, administered at a median of 5.0 [IQR 5.0, 7.5] weeks between cycles, led to decreased serum IgG levels in all patients and reduced AChR-Ab titers in seropositive patients. All patients showed sustained MG symptom improvement, with considerably reduced QMG scores before efgartigimod treatment. None of the patients required rescue medications or developed treatment-related adverse events. CONCLUSIONS: Customized efgartigimod administration intervals effectively enhanced clinical outcomes in patients with MG without notable symptom fluctuations, demonstrating the benefits of individualized treatment approaches and validating the safety of efgartigimod during the study period.

Ten-year fracture risk in Japanese patients with myasthenia gravis: A comprehensive assessment using the fracture risk assessment tool.

BACKGROUND: Myasthenia gravis (MG) is an immune disorder that causes muscle weakness with an increasing prevalence, particularly among the elderly in Japan. Glucocorticoid treatment for MG is problematic for bone health because of reduced bone density and increased fracture risk. The fracture risk assessment tool (FRAX®) can estimate fracture risk, but its applicability in patients with MG remains uncertain. METHODS: A prospective cohort study was conducted on 54 patients with MG between April and July 2012. Bone mineral density (BMD) was measured, and FRAX® scores were calculated with and without BMD. We also adjusted FRAX® scores based on glucocorticoid dosage. Patients were monitored for major osteoporotic fractures (MOF) until June 2022. Statistical analyses included Kaplan-Meier curves and Cox proportional hazards models. RESULTS: The study group included 12 men and 42 women with a mean age of 62 years. Higher FRAX® scores correlated with increased fracture risk, particularly in the hip and lumbar regions. The 10-year fracture-free rate was significantly lower in the high-FRAX® score group. The FRAX® score using BMD is a significant predictor of MOF risk. The hazard ratio for FRAX® scores was 1.17 (95% CI 1.10-1.26). CONCLUSION: We demonstrated the effectiveness of the FRAX® tool in assessing fracture risk among patients with MG. High FRAX® scores correlated with increased fracture risk, emphasizing its importance. These findings support the incorporation of FRAX® assessment into clinical management to enhance patient care and outcomes. However, the small sample size and observational nature suggest a need for further research.

A Multifaceted Approach to Seizure Management in a Patient With Down Syndrome, Obstructive Sleep Apnea, and Hypothyroidism: A Case Report.

In this case study, a 16-year-old male with Down syndrome (DS) faced persistent nocturnal seizures despite anti-seizure medications and treatment for concurrent hypothyroidism. Obstructive sleep apnea (OSA), a common issue in patients with Down syndrome, was revealed as a trigger of the seizures. The implementation of continuous positive airway pressure (CPAP) therapy along with medication adjustments led to a significant decrease in seizure frequency, highlighting the importance of a comprehensive approach to seizure management in patients with complex medical conditions.