EMBRACE: One Small Story in Lupus-One Giant Challenge in Clinical Trials.

Clinical trials of novel therapeutics in the United States have not been adequately representative of diverse populations, particularly racial and ethnic minorities. The challenges and consequences of underrepresentation in clinical trial recruitment are exemplified by the case of belimumab, a biologic treatment for systemic lupus erythematosus (SLE), a disease that is more prevalent in patients of Black African ancestry and of Hispanic/Latino ethnicity than in other patient populations. Although belimumab was found to be effective in phase 2 and 3 clinical trials in the general population, post hoc analyses of efficacy data in patients of Black African ancestry showed inconsistent results. Consequently, a cautionary statement regarding belimumab use in this population was added to the product label. To alleviate concerns that belimumab may not be safe and effective for patients of Black African ancestry, the Efficacy and Safety of Belimumab in Black Race Patients with SLE (EMBRACE) study was conducted in a post-marketing commitment to the Food and Drug Administration. The study recruited only patients who self-identified as being of Black race; its findings led to the removal of the cautionary labeling of belimumab use in patients of Black African ancestry. Our manuscript highlights the critical lessons learned from the successes and failures of the EMBRACE study. It also provides suggestions for overcoming health disparities, highlighting strategies for conducting well-designed clinical trials to overcome systematic barriers to diversity in recruitment, with a focus on enacting long-term support to ensure equity in the process, products, and benefits from drug development and clinical trials.

Use of acetaminophen and sucralose as co-analytes to differentiate sources of human excreta in surface waters.

Reducing pathogenic risks in surface waters impacted by leaking or overflowing sewage requires the ability to detect human excreta in raw sewage, discriminate human excreta from other types of animal excreta, and differentiate between treated wastewater and raw sewage. We used the relative concentrations of a degradable, human-specific pharmaceutical and a persistent artificial sweetener to indicate the presence of human excreta, its degree of environmental degradation, and the amount of dilution by freshwater sources. Samples were collected and analyzed for acetaminophen and sucralose between 2016 and 2018 from wastewater treatment plants (WWTPs) and streams in metropolitan Lexington, Kentucky (USA). Both co-analytes were consistently present in raw sewage, with acetaminophen in higher concentrations than sucralose. The presence of acetaminophen was related primarily to untreated human excreta, with concentrations rapidly decreasing upon treatment to nearly undetectable levels in WWTP effluents and streams. Sucralose in surface waters was related to inputs of both raw sewage and WWTP effluents. The ratio of acetaminophen to sucralose concentrations in raw sewage and spiked river waters exhibited linear decay kinetics with respect to time, with larger decay constants observed at higher temperatures. This co-analyte indicator approach was evaluated at a local site previously suspected of receiving raw sewage. The presence and ratios of the co-analytes indicated the presence of domestic sewage that was not fully treated.

SWGDAM developmental validation of a 19-locus Y-STR system for forensic casework.

A Scientific Working Group on DNA Analysis Methods (SWGDAM) developmental validation study was carried out on two Y-STR multiplex systems (MPI and MPII) that collectively permit the co-amplification of 19 Y-STR markers, including DYS393, DYS392, DYS391, DYS389I, DYS389II, Y-GATA-A7.2 (DYS461), DYS438, DYS385a and DYS385b (MPI); DYS425, DYS388, DYS390, DYS439, DYS434, DYS437, Y-GATA-C.4, Y-GATA-A7.1 (DYS460), Y-GATA-H.4, and DYS 19 (MPII). Performance checks subsequent to PCR parameter optimization indicated that MPI and MPII were suitably reproducible, precise and accurate for forensic use. The sensitivity of the systems was such that a full 19-locus Y-STR profile was obtainable with 150-200 pg of male DNA, and some loci were detectable even with as little as 20-30 pg of input DNA. Primate specificity was demonstrated by the lack of cross-reactivity with a variety of commonly encountered bacterial and animal species, with the single exception of a monomorphic canine product that was outside of the size range of human alleles from any of the 19 loci. Not surprisingly, cross-reactivity was observed with a number of male and female nonhuman primates. Environmentally compromised samples produced full or partial Y-STR profiles. For example, a semen stain exposed to the outdoor elements for six months still gave a 13-locus Y-STR profile. Although a limited number of female DNA artifacts were observed in mixed stains in which the male DNA comprised 1/300 of the total, the full 19-locus male profile was easily discernible. Even at a 1500-to-2000-fold dilution of male DNA with female DNA partial Y-STR profiles were obtained. Furthermore, the potential utility of MPI and MPII for forensic casework is exemplified by their ability to dissect out the male haplotype in a variety of case-type samples, including, inter alia, post-coital vaginal swabs, admixed male and female bloodstains, the nonsperm fraction from a differentially extracted semen stain, and determination of the number of male donors in mixed semen stains.