Randomized pilot trial of eight weeks of bedaquiline (TMC207) treatment for multidrug-resistant tuberculosis: long-term outcome, tolerability, and effect on emergence of drug resistance.

The 2-year follow-up results for a randomized placebo-controlled study of 47 patients with multidrug-resistant pulmonary tuberculosis treated with either the new diarylquinoline TMC207, recently renamed bedaquiline, or placebo, added to the first 8 weeks of a background regimen, are presented. Bedaquiline significantly reduced the time to culture conversion over 24 weeks (hazard ratio, 2.253; 95% confidence interval, 1.08 to 4.71; P = 0.031). With the exception of nausea reported in 26% of patients receiving bedaquiline and none receiving placebo, adverse events occurred at similar frequencies in both groups of patients: bilateral hearing impairment, extremity pain, acne, and noncardiac chest pain occurred in 13 and 21%, 17 and 13%, 9 and 17%, and 4 and 17% of patients, respectively, receiving bedaquiline or placebo. Excluding resistance to ethambutol and ethionamide, only one patient receiving bedaquiline acquired resistance to companion drugs, but five patients receiving placebo (4.8% versus 21.7%; P = 0.18) acquired resistance to companion drugs, and resistance to ofloxacin was acquired in four patients receiving placebo and none receiving bedaquiline (0% versus 22%; 0 = 0.066). In all, 23 patients (49%), including 13 receiving placebo (54%) and 10 receiving bedaquiline (44%), discontinued the study prior to its completion, 12 during the first 24 weeks of treatment. Eight subjects were withdrawn for noncompliance or default, and seven withdrew consent, citing the rigorous program of investigations for safety and pharmacokinetic monitoring. Bedaquiline may contribute to the management of multidrug-resistant tuberculosis by effecting more rapid sputum culture negativity and by preventing acquired resistance to companion drugs.

Distribution of metamitron-resistant Chenopodium album L. in Belgian sugar beet.

Chenopodium album L. (fat-hen) with a Ser264-Gly mutation is resistant to photosystem II-inhibiting herbicides like the triazinone metamitron, a key herbicide in sugar beet. In recent years, this resistant biotype may cause unsatisfactory weed control in Belgian sugar beet. However, the dimension of the problem was yet unknown. Therefore, a survey was conducted in 2008 covering the whole Belgian sugar beet area. In randomly selected fields, C. album plants surviving weed control were counted and sampled. First, the number of surviving plants was used to estimate the prevalence of fields with unsatisfactory control and to classify the surveyed fields. Then, the share of the resistant biotype in each field was determined with cleaved amplified polymorphic sequence-analysis (CAPS-analysis) on sampled leaves. Finally, all results were visualised on the map of Belgium. Twenty percent of the fields had more than 500 surviving plants per hectare and were thus classified as fields with unsatisfactory C. album control. The resistant biotype was present in 95% of these fields and even in 74% of the sampled fields with good weed control. No pattern was found during mapping. These results indicate that the metamitron-resistant biotype has spread over the whole sugar beet area but that it is not (yet) causing severe problems in every field. To get a more accurate estimation of the portion of resistant plants in the field and the effect of herbicide treatment on this biotype, an elaborate survey will be conducted in 2010 on fields that have both untreated and treated plots installed.

Chlorophyll fluorescence protocol for quick detection of triazinone resistant Chenopodium album L.

Sugar beet growers in Europe are more often confronted with an unsatisfactory control of Chenopodium album L. (fat-hen), possibly due to the presence of a triazinone resistant biotype. So far, two mutations on the psbA-gene, i.e. Ser264-Gly and Ala251-Val, are known to cause resistance in C. album to the photosystem II-inhibiting triazinones metamitron, a key herbicide in sugar beet, and metribuzin. The Ser264-Gly biotype, cross-resistant to many other photosystem II-inhibitors like the triazines atrazine and terbuthylazine, is most common. The second resistant C. album biotype, recorded in Sweden, is highly resistant to triazinones but only slightly cross-resistant to terbuthylazine. Since farmers should adapt their weed control strategy when a resistant biotype is present, a quick and cheap detection method is needed. Therefore, through trial and error, a protocol for detection with chlorophyll fluorescence measurements was developed and put to the test. First, C. album leaves were incubated in herbicide solution (i.e. 0 microM, 25 microM metribuzin, 200 microM metamitron or 25 microM terbuthylazine) during three hours under natural light. After 30 minutes of dark adaptation, photosynthesis yield was measured with Pocket PEA (Hansatech Instruments). In Leaves from sensitive C. album, herbicide treatment reduces photosynthesis yield due to inhibition of photosynthesis at photosystem II. This results in a difference of photosynthesis yield between the untreated control and herbicide treatment. Based on the relative photosynthesis yield (as a percentage of untreated), a classification rule was formulated: C. album is classified as sensitive when its relative photosynthesis yield is less than 90%, otherwise it is resistant. While metribuzin, and to a lesser extent, metamitron treatment allowed a quick detection of triazinone resistant C. album, terbuthylazine treatment was able to distinguish the Ser264-Gly from the Ala251-Val biotype. As a final test, 265 plants were classified with the protocol. Simultaneously, a CLeaved Amplified Polymorphic Sequence (CAPS)-analysis was conducted on the same plants to verify the presence of the Ser264-Gly mutation. Only one mismatch was found when results of both detection methods were compared. The test results illustrate that this protocol provides a reliable, quick and cheap alternative for DNA-analysis and bio-assays to detect the triazinone resistant C. album biotypes.

Effect of repeated doses of darunavir plus low-dose ritonavir on the pharmacokinetics of sildenafil in healthy male subjects: phase I randomized, open-label, two-way crossover study.

BACKGROUND AND OBJECTIVES: Darunavir (DRV, TMC114) is a novel protease inhibitor administered in combination with low-dose ritonavir (DRV/r) and is highly active against both wild-type and multidrug-resistant HIV-1 strains. Sildenafil is an oral therapy for erectile dysfunction. Concomitant administration of protease inhibitors and sildenafil increases sildenafil plasma concentrations. The potential for a pharmacokinetic drug interaction exists when sildenafil and DRV/r are co-administered, as these drugs are primarily metabolized by cytochrome P450 (CYP) 3A, and darunavir and ritonavir are CYP3A inhibitors. The primary objective of this open-label, crossover, phase I study was to assess the effect of multiple doses of DRV/r on the pharmacokinetics of sildenafil and its active metabolite N-desmethyl sildenafil. The secondary objective was to assess the short-term safety and tolerability of co-administration of sildenafil and DRV/r. METHODS: Sixteen HIV-negative healthy male subjects were randomized to one of two sequences. In two sessions each subject received treatments A and B. In treatment A, a single dose of sildenafil 100 mg was administered. In treatment B, the subjects received DRV/r 400/100 mg twice daily for 8 days and on day 7 a single dose of sildenafil 25 mg was co-administered. Full pharmacokinetic profiles of sildenafil, N-desmethyl sildenafil, darunavir and ritonavir were determined. Safety and tolerability were also assessed. RESULTS: Sildenafil exposure (area under the plasma concentration-time curve [AUC]) was comparable between the two treatments despite administration of a lower dose of sildenafil (25 mg) with DRV/r than when sildenafil (100 mg) was administered alone. When sildenafil 25 mg was co-administered with DRV/r, the sildenafil maximum plasma concentration (Cmax) was 38% lower compared with Cmax after administration of sildenafil alone at a dose of 100 mg. N-desmethyl sildenafil Cmax and AUC from the time of administration until the last time point with a measurable concentration after dosing (calculated by linear trapezoidal summation [AUClast]) values decreased by approximately 95% when sildenafil 25 mg was co-administered with DRV/r compared with sildenafil 100 mg alone. Combined treatment with DRV/r and sildenafil was generally safe and well tolerated. CONCLUSION: Sildenafil exposure is increased in the presence of DRV/r. In this setting, a dose adjustment for sildenafil is warranted; no more than 25 mg of sildenafil is recommended over a 48-hour period when co-administered with DRV/r.

Early bactericidal activity and pharmacokinetics of the diarylquinoline TMC207 in treatment of pulmonary tuberculosis.

Tibotec Medicinal Compound 207 (TMC207) is a novel diarylquinoline with a unique mode of action that targets mycobacterial ATP synthase. TMC207 exhibits high in vitro activity against mycobacterial strains either susceptible or resistant to all first-line and many second-line drugs, including fluoroquinolones, and has shown exceptional in vivo activity against several mycobacterial species in different animal models. In this early bactericidal activity study, 75 treatment-naïve patients with smear-positive pulmonary tuberculosis were randomized to once-daily oral TMC207 (25 mg, 100 mg, or 400 mg), 600 mg rifampin (RIF), or 300 mg isoniazid (INH) for 7 days. Sixteen-hour overnight sputum collected at baseline and on each treatment day was plated in serial dilutions on selective agar plates. The bactericidal activity was expressed as the log(10) decrease in CFU/ml sputum/day. Pharmacokinetic sampling was performed on day 7 of TMC207 administration up to 24 h postdose. The decreases in log(10) CFU counts (+/- standard deviation) from baseline to day 7 were 0.04 +/- 0.46 for 25 mg TMC207 (n = 14), 0.26 +/- 0.64 for 100 mg TMC207 (n = 14), 0.77 +/- 0.58 for 400 mg TMC207 (n = 14), 1.88 +/- 0.74 for INH (n = 11), and 1.70 +/- 0.71 for RIF (n = 14). Significant bactericidal activity of 400 mg TMC207 was observed from day 4 onward and was similar in magnitude to those of INH and RIF over the same period. The pharmacokinetics of TMC207 were linear across the dose range. In summary, TMC207 demonstrated bactericidal activity with a delayed onset and was well tolerated, and no study drug-related serious adverse events occurred.

Resistance of Chenopodium albumto photosystem II-inhibitors.

Chenopodium album L. (fat-hen), a highly competitive and very prolific species, is a common weed in most spring- and summer-sown crops such as maize, sugar beet and vegetables. In the late seventies, C. album stepped into the limelight as a problem weed in maize. Frequent use of atrazine in maize monoculture did select for plants having a Ser-264-Gly mutation on the psbA gene resulting in atrazine-resistance and cross-resistance to other Photosystem (PS) II-inhibitors. The psbA gene encodes the D1 protein of PS II which is the target site of PS II-inhibitors. Introduction of new herbicides made it possible to control this atrazine-resistant biotype in maize, which allowed C. album to fade into the background again until it resurfaced some years ago as a problem weed in European sugar beet (Belgium, France, The Netherlands and Sweden). Greenhouse bioassays at Ghent University revealed that the unsatisfactory control of C. album in sugar beet is due to resistance to the triazinone metamitron, a key herbicide in sugar beet. The expected cross-resistance to atrazine and metribuzin was found in all populations except for a Swedish one, which is highly resistant to metamitron and metribuzin but not to atrazine. DNA sequence analysis confirmed the presence of a Ser-264-Gly mutation for all populations that are both metamitron- and atrazine-resistant. The Swedish population has an Ala-251-Val mutation on the psbA gene explaining its aberrant (cross)-resistance profile. The occurrence of C. album biotypes with resistance to metamitron but different genotypes and cross-resistance profiles could raise the question which herbicide(s) did select for the resistance. In Sweden, having no history of atrazine use, the triazinones metamitron, used in sugar beet, and metribuzin, used in rotational potato, could have selected for resistance. In Belgium, at least three different herbicides and/or crop rotations could have contributed to resistance development: (1) a record of continuous use of atrazine in maize resulting in triazine-resistant C. album in the seed bank, (2) metamitron use in sugar beet and (3) metribuzin use in potato.

Chlorophyll fluorescence tests for monitoring triazinone resistance in Chenopodium album L.

Recently, fat-hen (Chenopodium album L.) biotypes resistant to metamitron, a key herbicide in sugar beet, were recorded. Pot experiments revealed that these biotypes showed cross-resistance to metribuzin, a triazinone used in potato. Greenhouse and laboratory experiments were performed to develop resistance monitoring tests, so that resistant biotypes can be detected quickly and farmers may adapt their weed management. Resistant and susceptible biotypes were grown in a greenhouse under conditions of natural and artificial light at an intensity of 100 micromol photons m(-2) s(-1). Leaves were collected and, immersed in a solution of 1000 microM metamitron and 500 microM metribuzin, exposed to natural and artificial light (1000, 750 and 100 micromol photons m(-2) s(-1) respectively). After this, chlorophyll fluorescence measurements were carried out. The results revealed that the photosynthetic electron transport of metamitron- and metribuzin-incubated leaves of resistant biotypes decreased less than that of the incubated Leaves of susceptible biotypes. The differences between the metribuzin-incubated leaves of the susceptible and resistant biotypes were larger than those observed with the metamitron-incubated leaves. The aim of the experiments was to optimise the chlorophyll fluorescence test and to find a sufficiently high correlation between the results of the pot experiments and the chlorophyll fluorescence measurements.

Effect of selected sugar beet herbicides on germination of various Chenopodium album populations.

Seeds of various fat-hen populations (Chenopodium album L.), mostly originating from sugar beet fields, were subjected to treatments with the following herbicides: metamitron, acetochlor, dimethenamid-P and S-metolachlor. Herbicides were applied either incorporated into a sandy Loam soil (2005-2007) and/or on filter paper in Petri dishes (2006-2007). Results between experiments were highly contrasting. Soil applications of metamitron, acetochlor and S-metolachlor were stimulating germination in the 2005 experiments, whereas in the 2006-2007 experiments effects were ranging from slightly stimulating to highly inhibitory.

Cytokine gene expression in dams and foetuses after experimental Neospora caninum infection of heifers at 110 days of gestation.

Neospora caninum is a major cause of abortion in cattle. An essential role for Th1 cytokines, such as IFN-gamma and IL-12 in protective immunity against N. caninum in murine models has been indicated. However, little is known about immunity to Neospora in pregnant cattle where a considerable level of immunomodulation may exist. In this study, the immune response of heifers infected early in the second trimester of pregnancy by intravenous inoculation of N. caninum tachyzoites was compared with immune responses in uninfected pregnant heifers. Animals were killed 3 weeks after infection. No abortion was observed in any infected dam, however, transplacental infection was shown to have already taken place. Infection with N. caninum during pregnancy induced significant immune responses in both dams and their foetuses. Infected dams showed significant changes in lymphocyte subpopulations compared with uninfected pregnant animals and these changes were compartmentalized. Increased levels of T lymphocytes were observed in the infected foetuses. Cytokine gene expression analysed by real time RT-PCR showed increased expression of both Th1 and Th2 cytokines in N. caninum infected animals. This cytokine expression could have a role in the transplacental transmission of the parasite and/or mediate tissue damage.

Identification of Ostertagia ostertagi specific cells in bovine abomasal lymph nodes.

To investigate the contribution of different bovine cell subpopulations in the development of in vitro induced responses by Ostertagia ostertagi third larval antigen extract (L3), bovine abomasal lymph node cell suspensions were depleted of specific cell populations. The depleted cell suspensions were subsequently assayed for their proliferative responses to O. ostertagi L3 antigen extract. Proliferative responses to O. ostertagi L3 antigen extract were restricted to a CD2+ CD4- CD8- cell population and MHC II+ cells different from B-cells were of major importance. Depletion of CD4, CD8, CD4CD8, IgM or CD21 positive cells did not decrease proliferation to L3 antigen extract. Depletion of gammadelta T-cells, which also comprise a subpopulation of CD2+ CD4- CD8- cells, reduced proliferation to L3 antigen extract only in one animal. The results suggest that either gammadelta T-cells could be involved in the proliferation or that another as yet unidentified population is important for proliferation. The precise role of these populations during infection with O. ostertagi and the mechanism by which these cells may influence the host immune response are important issues that remain to be elucidated.

Oral infection of calves with Neospora caninum oocysts from dogs: humoral and cellular immune responses.

Neospora caninum has been identified as a major cause of abortion in cattle in a number of countries throughout the world. Until the recent demonstration that dogs can serve as a definitive host of this parasite, it was not possible to study the infection in cattle orally exposed to oocysts. The aim of this study was to investigate the potential of N. caninum oocysts to infect calves, and to define initial immune responses that arise after oral infection. Seven calves were fed approximately 10(4)-10(5) N. caninum oocysts, three calves served as uninfected controls. Before infection, all calves were serologically negative for anti-Neospora antibodies and the calves were non-reactive to Neospora antigen in an in vitro lymphocyte proliferation assay. Peripheral blood lymphocytes from inoculated calves were able to mount in vitro proliferative responses to crude N. caninum antigen extract as early as 1 week p.i. Within 2 and 4 weeks p.i., Neospora-specific IgG1 and IgG2 antibodies were detected by IFAT and ELISA in serum from infected calves but not from sham-infected calves. The continued presence of reactive cells in the blood, spleen and mesenteric, inguinal, bronchial lymph nodes was seen as late as 2.5 months p.i., and parasite DNA was detected in the brain and spinal cord of the infected animals by PCR, indicating that the cattle were infected by oral inoculation of N. caninum oocysts collected from dogs, and that the animals were systematically sensitised by parasite antigen.

Induction and suppression of lymphocyte proliferation by antigen extracts of Ostertagia ostertagi.

To obtain an insight into the responses of T-cells of cattle to Ostertagia ostertagi, the responses of peripheral blood and lymph node lymphocytes to O. ostertagi antigen extracts were determined in both exposed and naive calves. The lymphocyte responses induced by O. ostertagi antigen extracts of the third (L3) and fourth (L4) larval stages, as well as adult worms, were analysed. Although peripheral blood lymphocyte responses were very low or absent, abomasal lymph node lymphocytes of exposed animals showed a strong response to the L3 antigen extract. No such response was observed in naive calves or in mesenteric lymph node cells of exposed calves. L4 and adult worm antigen extracts suppressed the proliferative responses induced by the L3 antigen extract. Whether or not this suppressive effect plays a role in the slow rate at which protective immunity develops against O. ostertagi is under further investigation.

The effect of truncated infections with Ostertagia ostertagi on the development of acquired resistance in calves.

The relative contribution of the third (L3), fourth (L4) and adult stages of Ostertagia ostertagi to the development of immunity was assessed in calves which were either continuously infected during 21 weeks or subjected to infections truncated by anthelmintic treatment at the L3 or L4 stage. A fourth group remained uninfected (control group). Faecal samples and blood samples were collected weekly for faecal egg counts and determination of pepsinogen and antibody levels. Only the continuously infected animals showed positive egg counts, which fell towards the end of the primary infection period. Pepsinogen and antibody levels remained high in the continuously infected group until the end of the primary infection period. At that time, they were significantly higher compared to the control calves, with intermediate values in the truncated infection groups. After the 21 weeks primary infection period all animals were dewormed. To evaluate the protection provided by the different immunisation protocols, all animals were challenged 1 week later with 156000 Ostertagia L3, spread over 12 consecutive days. The marked reduction in egg counts following challenge infection indicated a certain degree of immunity in the continuously infected calves, which was confirmed at necropsy by the reduced worm burdens, the high percentage of inhibited early L4 larvae, the reduced size of the adult worms and the higher numbers of mucosal mast cells in this group. Numbers of globule leucocytes and eosinophils were not significantly different from the control group. Infections truncated by anthelmintic treatment elicited poor development of immunity as shown by the egg output after the challenge infection and the percentages of arrested larvae and the lengths of adult worms which were intermediate to those of the continuously infected calves and control animals.

Isolation, characterization and immunolocalization of a globin-like antigen from Ostertagia ostertagi adults.

Western blot analysis using an anti-globin rabbit serum Rb94 revealed a major band of 17 kDa in extracts of Ostertagia ostertagi adults and 4th-stage larvae. The adult stage globin-like antigen (OoAdGlb) was purified from total worm extracts by liquid chromatography. The protein has an estimated molecular mass of 36 kDa under non-reducing conditions, suggesting a dimeric structure containing 2 non-covalently linked 17 kDa monomers. Tryptic peptides were sequenced and showed strong similarities with the globins of free-living and parasitic nematodes. Immunolocalization revealed the presence of this globin-like antigen in the body wall musculature and/or the cuticle of O. ostertagi adults. An enzyme-linked immunosorbent assay based on the purified OoAdGlb showed no differences in response between calves infected by O. ostertagi and/or Cooperia oncophora and the negative controls.