An amyloid beta vaccine that safely drives immunity to a key pathological species in Alzheimer's disease: pyroglutamate amyloid beta.

Pyroglutamate amyloid beta3-42 (pGlu-Abeta3-42), a highly amyloidogenic and neurotoxic form of Abeta, is N-terminally truncated to form a pyroglutamate and has recently been proposed as a key target for immunotherapy. Optimized ACI-24, a vaccine in development for the treatment and prevention of Alzheimer's disease, focuses the antibody response on the first 15 N-terminal amino acids of Abeta (Abeta1-15). Importantly, clinical data with an initial version of ACI-24 incorporating Abeta1-15, established the vaccine's safety and tolerability with evidence of immunogenicity. To explore optimized ACI-24's capacity to generate antibodies to pGlu-Abeta3-42, pre-clinical studies were carried out. Vaccinating mice and non-human primates demonstrated that optimized ACI-24 was well-tolerated and induced an antibody response against Abeta1-42 as expected, as well as high titres of IgG reactive with pyroGlu-Abeta. Epitope mapping of the polyclonal response confirmed these findings revealing broad coverage of epitopes particularly for Abeta peptides mimicking where cleavage occurs to form pGlu-Abeta3-42. These data are in striking contrast to results obtained with other clinically tested Abeta targeting vaccines which generated restricted and limited antibody diversity. Taken together, our findings demonstrate that optimized ACI-24 vaccination represents a breakthrough to provide a safe immune response with a broader Abeta sequence recognition compared to previously tested vaccines, creating binders to pathogenic forms of Abeta important in pathogenesis including pGlu-Abeta3-42.

Caregiver perceptions about the impact of caring for patients with wet age-related macular degeneration.

PURPOSE: Caregivers of older persons with eye disease, namely age-related macular degeneration (AMD), have been reported to have a higher than expected distress. Very few studies have explored caregiver perceptions as to what is important when providing care. The aim of this study was to explore the perceptions of caregivers of persons with neovascular AMD in relation to the most important aspects of caring, as described in extended answers to self-administered survey questions. METHODS: A cross-sectional, self-administered survey of 643 caregivers of people with neovascular AMD, comprising 27 closed-response questions and 2 open ended questions. The latter were analysed as part of this study utilising and 'inductive' Grounded Theory approach. RESULTS: Six-hundred and forty-three caregiver responses to 2 open ended questions were analysed using an inductive approach and sorted into thematic networks. Three discrete categories arose: The Impact of Caring; Injections and Information and Activities of Daily Living. CONCLUSIONS: Most caregivers were family caregivers and were found to be compassionate and self-sacrificing. They accepted additional responsibility whilst providing an encouraging environment for their care recipient. As a result, they experience distress and consider their own needs as secondary. Very few seek or receive respite and this added burden can have a negative impact upon the relationship between caregiver and care recipient.

Evaluation of functional outcome measured by modified Rankin scale in rtPA treated patients with acute ischemic stroke.

Aim of our study was to assess functional outcome measured by modified Rankin scale (mRS) in patients that were treated with thrombolytic therapy-recombinant tissue plasminogen activator (rtPA) after acute ischemic stroke. The study included 100 participants that were treated after acute ischemic stroke. Analyzed parameters included: gender; age groups: age 54 and below (Groupup to-54), 55-64 (Group55-64), 65-74 (Group65-74), and 75 and above (Group75-up); cerebral blood flow (CBF) and cerebral blood volume (CBV). Considering time of rtPA administration, we analyzed 3 groups: between 1-2 hours from stroke onset (Time1-2h), 2-3 hours (Time2-3h) and 3-4.5 hours (Time3h-up). NIHSS scores were analyzed: NIHSS 1-at admission and NIHSS 2-at discharge from hospital; and mRS values: RANKIN 1-at admission and RANKIN 2-at discharge from hospital. There is significant reduction in NIHSS and mRS scores between two measurements for all groups of evaluated parameters. CBF, CBV and NIHSS values at admission significantly correlated with mRS scores at admission (p<0.01), as well as with mRS scores at discharge except for CBF where statistical significance was (p=0.019). Significantly lower values of NIHSS at admission (p<0.01), CBF values (p<0.01) and CBV values (p<0.01) are noticed in the group with mRS≤2. Early induction of rtPA treatment in patients with acute ischemic stroke within first 4.5 hours significantly increases positive treatment outcome in both genders and for all evaluated age groups. Favorable outcome (mRS≤2) at the time of discharge from hospital is significantly associated with lower NIHSS values at admission.

Influence of crystal modification on the photoinduced color change in riboflavin.

Two different qualities of riboflavin (RF) i.e., synthetic (RFs) and biosynthetic riboflavin (RFbs) have been investigated with respect to photoinduced color change in the solid state. Several methods (XRD, FT-IR, VIS-, NIR- and fluorescence spectroscopy) were employed to elucidate the properties of the crystalline structure of RFs and RFbs and the influence of irradiation on the color and structural changes of the samples in the solid state. It was shown that RFs an RFbs represent two different crystal modifications of riboflavin and that RFbs can easily be transformed into a dihydrate upon exposure to humidity. Based on the observed irreversible color change and reduction in fluorescence intensity upon irradiation, an irreversible photoreduction of the molecule was assumed in case of RFs. A more pronounced, reversible color change and reversible reduction in fluorescence intensity indicated a reversible photoreduction process in the case of RFbs. The mechanism of these processes was further investigated by means of NIR and FT-IR spectrophotometry. It is apparent from the current study that the crystal modification of RF can strongly influence the solid state photochemistry of this molecule.

Solid dispersions for preparation of phototoxic supersaturated solutions for antimicrobial photodynamic therapy (aPDT): Studies on curcumin and curcuminoides L.

Curcumin is under investigation as a potential photosensitizer (PS) in antimicrobial photodynamic therapy (aPDT). The therapeutic potential of curcumin as a PS is limited by its low aqueous solubility, susceptibility to hydrolytic and photolytic degradation, and limited phototoxicity toward Gram negative (G-) bacteria. Supersaturated solutions of curcumin have demonstrated high phototoxicity toward several species of Gram positive (G+) bacteria as well as the G-Escherichia (E) coli. Thus, solid dispersions that can form supersaturated solutions of curcumin upon hydration may be beneficial in aPDT. In the present study, solid dispersions of curcumin have been prepared through lyophilization of concentrated solutions obtained from dissolution of hydroxypropyl-ß-cyclodextrin (HPßCD)-curcumin co-precipitates. Hydroxypropyl methylcellulose (HPMC) was added to curcumin solutions prior to lyophilization. The resulting lyophilizates were porous, amorphous and hydrated and dissolved rapidly in contact with a model physiological salt solution. The detected drug load of the lyophilizates was in the range 0.5-1.0% (w/w) and was dependent on the selected ratio between HPßCD and curcumin in the co-precipitate. The lyophilizate with the highest drug load could easily be dissolved in aqueous medium to form curcumin solutions of relevant concentrations for aPDT (i.e., 10µM). Selected solutions of the curcumin solid dispersions showed a pronounced decrease in curcumin concentration up to 90% after storage for 168h, which indicated that supersaturated curcumin solutions were initially formed upon dissolution of the lyophilizates. Both freshly prepared and 2days old solutions of one selected curcumin lyophilizate induced significant inactivation of E. coli (∼1% bacterial survival) after exposure to a light dose of only 5J/cm(2).

Clinical features and outcome of 2009-influenza A (H1N1) after allogeneic hematopoietic SCT.

The impact of the 2009 H1N1-Influenza A (H1N1) pandemic in allogeneic hematopoietic SCT recipients (allo-HSCT) is not yet well defined. Between May 2009 and May 2010, all allo-HSCTs who presented with respiratory symptoms were screened for the presence of the H1N1 virus. Oseltamivir resistance was assessed and chart reviews were performed for all cases. In all, 51 of 248 (20%) allo-HSCT recipients followed at our outpatient clinic were screened. We identified 10 patients with H1N1 infection. Close contact with children was the most commonly suspected mode of transmission. Upper and lower respiratory tract infections were present in eight and five patients, respectively. Lymphopenia (<1 G/L) was the most frequent biological abnormality. High immunosuppression was responsible for severe infection requiring mechanical ventilation associated with prolonged viral shedding in three patients who had significant comorbidities and GvHD. Two of them developed an oseltamivir-resistant strain and both patients died subsequently despite intensive therapy, resulting in a case fatality rate of 20%. In conclusion, although most allo-HSCTs had mild symptoms from H1N1 infection, severe immunosuppression and emergence of oseltamivir resistance were likely responsible for a substantial morbidity, further supporting the need for vaccination and monitoring of close contacts, especially children.

Do NK cells contribute to the pathophysiology of transplant-associated thrombotic microangiopathy?

Transplant-associated thrombotic microangiopathy (TA-TMA) is a life-threatening complication caused by the aggregation of platelets exposed to the thrombogenic subendothelial matrix of injured endothelial cells. Here, we present a case of a patient transplanted for idiopathic aplastic anemia with a T-cell depleted hematopoietic stem cell graft from an HLA-C mismatched unrelated donor. At day 7 posttransplant, she suffered from acute renal failure with hematuria. The presence of numerous schistocytes, an increased level of lactate dehydrogenase and a renal biopsy with multiple vascular injuries confirmed the diagnosis of severe TA-TMA. At day 14, she developed graft versus host disease and died 7 months posttransplantation of multiorgan failure. At day 15, we observed a sizable population of natural killer (NK) cells in the peripheral blood, the number of which reached 0.8 G/L at 4 months posttransplant. Most NK cells lacked inhibitory killer immunoglobulin-like receptors (KIR) specific for the KIR-ligands expressed in the patient. NK cells were also abundantly present in pericardial and pleural fluids and had invaded the kidney, where they colocalized with the renal vasculopathy. Because there are several mechanisms through which NK cells and platelets can activate each other reciprocally, it is conceivable that NK cells contribute to TA-TMA and its progression.

Determination of autoprotolysis constants of some non-aqueous solvents using coulometric titration.

Autoprotolysis constants of acetonitrile, propionitrile, nitromethane, ethylene carbonate and dimethyl sulphoxide were determined using a coulometric - potentiometric method with a hydrogen/palladium electrode as generator. The method is based on the titration of a strong base, tetrabutylammonium hydroxide, with H(+) ions generated by anodic oxidation of hydrogen dissolved in palladium. The titration was carried out in a galvanic cell with glass and calomel electrodes at 25 degrees C. The pK(s) values for the investigated solvents are: acetonitrile, 28.8; propionitrile, 24.6; nitromethane, 23.7; ethylene carbonate. 21.5; and dimethyl sulphoxide 29.1. These data are in accordance with those reported in the literature.