Real-world safety and effectiveness of mepolizumab for patients with eosinophilic granulomatosis with polyangiitis (EGPA) in Japan: 48-week interim analysis of the MARS study.

OBJECTIVES: : Assess real-world, long-term safety/effectiveness of mepolizumab for eosinophilic granulomatosis with polyangiitis (EGPA) in Japan. METHODS: : MARS (GSK ID:213684/NCT04551989) is an ongoing 96-week study of patients with EGPA who received 4-weekly mepolizumab 300 mg subcutaneously for ≥96 weeks before study entry (baseline) and continued treatment. This interim analysis included safety from baseline to Week 48 (observation period) and clinical outcomes before mepolizumab and during the observation period. RESULTS: : Of 118 patients enrolled, 29% (34/118) experienced adverse events (AEs) of which 13% (15/118) experienced serious AEs; none were considered mepolizumab-related. Median oral corticosteroid (OCS) dose decreased from 6.9 (pre-mepolizumab) to 3.0 (baseline) and 2.0 mg/day (Weeks 45-48); the proportion of patients receiving no OCS increased from 8% to 32% and 38%, respectively. Patients experiencing clinical symptoms decreased from 94% (pre-mepolizumab) to 73% (baseline) and 67% (Week 48). During the observation period, 5% of patients experienced EGPA relapse; rates of EGPA-related hospitalisations, EGPA-related emergency room/unscheduled visits and asthma exacerbations were 0.05, 0.09 and 0.08 event/person-year, respectively. CONCLUSIONS: : Results of mepolizumab treatment for ≥144 weeks (before baseline plus observation) were consistent with the known safety profile and allowed OCS dose reduction while improving disease control versus pre-treatment among patients with EGPA.

New pitfalls of high-density postmortem computed tomography.

An 80-year-old female was transferred to the hospital due to a traffic accident. Multiple cranial bone fractures with intracranial hemorrhage and intracranial air were detected. Despite treatment, the patient died after 6h. Twenty-one hours after the patient died, her whole body was scanned by postmortem CT, and a region of high density was detected within the left putamen. The autopsy revealed a cerebral contusion and multiple skull base fractures. Moreover, superabsorbent polymers (SAPs) were found within the left lateral ventricle and adjacent to the putamen, which appeared as a high-density lesion on postmortem CT at the left putamen, where the SAPs were compacted. Both ante- and postmortem conditions should be considered to prevent misdiagnoses based only on postmortem CT.

An automated evaluation system for analyzing antinociceptive effects on intracolonic capsaicin-induced visceral pain-related licking behavior in mice.

INTRODUCTION: The development of automated detection systems for animal behaviors is increasing in value in terms of saving time, objective analysis and reducing the need for well-trained experimenters. SCLABA(®) (Noveltec Inc., Kobe, Japan) is a commercially available analysis system originally developed for analyzing scratching behaviors in rodents, based on distances between points in videotaped images. Here, we used this software to automate analysis of abdominal licking behavior associated with visceral pain in mice. METHODS: Yellow and green spots were applied to the snout and the lower abdominal region of mice respectively to provide reference points for automated analysis of video recordings. Abdominal licking behavior after intracolonic administration of 0.3% capsaicin solution as a measure of visceral pain was determined based on changes in the inter-spot distance. RESULTS: A distance threshold between the colored spots was chosen based on manual measurements showing that 99% of minimal distances were below this threshold. Using this threshold, the number of licks determined by the automated analysis significantly and positively correlated with that determined by manual observation (R(2)=0.95 and p<0.001). The neurokinin-1 receptor antagonist GR205171A dose-dependently inhibited capsaicin-induced licking detected by automated analysis. DISCUSSION: We demonstrated that visceral pain-related licking behaviors after intracolonic capsaicin treatment can be automatically detected by applying commercially available image analysis software. This automated experimental system is very efficient and useful to evaluate antinociceptive effect of a test compound on visceral pain.

Automated experimental system capturing three behavioral components during murine forced swim test.

AIMS: An automated experimental system applying a commercially available video image analyzer was developed for the simultaneous detection and measurement of three behavioral components; immobility, swimming (horizontal movements) and climbing (vertical movements) that occur in the murine forced swim test (FST). The system was validated using four typical antidepressants. MAIN METHODS: System validity was confirmed by demonstrating no significant difference in 6 min time course of control group and imipramine-dosed group (30 mg/kg) between manual examinations and automated digital analysis for all the three behaviors (i.e., correlation coefficients were 0.96, 0.83 and 0.94 for immobility, swimming and climbing, respectively). The effects of acute single treatment with four antidepressants in clinical use, i.e., imipramine, desipramine, bupropion and fluvoxamine were evaluated at doses of 15, 30 and 60 mg/kg using the system. KEY FINDINGS: In 2-4 min time span analysis, all four antidepressants reduced immobility and increased climbing significantly, desipramine and bupropion increased swimming significantly, while imipramine and fluvoxamine did not. SIGNIFICANCE: The automated experimental system enabled efficient and accurate analysis of the three murine behaviors during FST at once. Climbing could be more sensitive parameter to detect anti-depressant-like effect than immobility in this system.

Pharmacologically distinctive behaviors other than burying marbles during the marble burying test in mice.

In the marble burying test, we focused on the 5 distinctive behavioral parameters of mice other than burying marbles, i.e. digging, latency to the first digging, exploration around marbles, rearing and locomotor activity. Typical anxiolytics or antidepressants with different mechanisms, fluvoxamine (30 mg/kg, selective serotonin reuptake inhibitor), bupropion (60 mg/kg, noradrenaline and dopamine reuptake inhibitor), imipramine (60 mg/kg, tricyclic antidepressant) and diazepam (10 mg/kg, benzodiazepine) were used to examine whether these behavioral parameters are sensitive to pharmacological treatments. Each of the drugs demonstrated an individual action pattern on the 4 behavioral parameters (latency to the first digging, exploration around marbles, rearing and locomotor activity). On the other hand, all 4 drugs reduced burying marbles and digging, which were correlated with each other. These results suggest that the former 4 behavioral parameters are sensitive to pharmacological treatment and that pharmacological regulation mechanisms of them may be different from burying marbles and digging. They could be useful to identify the type of action of a test drug like selective serotonin reuptake inhibitor, noradrenaline and dopamine reuptake inhibitor, tricyclic antidepressant or benzodiazepine.

Neurochemical responses to antidepressants in the prefrontal cortex of mice and their efficacy in preclinical models of anxiety-like and depression-like behavior: a comparative and correlational study.

RATIONALE: Marble burying and forced swimming behavior are widely used and sensitive tests for identifying clinically effective antidepressant drugs, although the underlying neurobiology of these behaviors is not fully elucidated. OBJECTIVES: The objective of this study was to determine the relationship between the behavioral effects of antidepressant drugs and their ability to modulate extracellular neurotransmitter levels in the prefrontal cortex. MATERIALS AND METHODS: The effects of fluoxetine, fluvoxamine, citalopram, imipramine, and desipramine (0 to 60 mg/kg by oral gavage, except fluoxetine at 0 to 40 mg/kg) were studied independently in CD-1 mice in the marble-burying task, forced swim task and on extracellular concentrations of serotonin, norepinephrine, and dopamine in the prefrontal cortex by freely moving microdialysis. RESULTS: Fluvoxamine, fluoxetine, and citalopram all suppressed marble-burying behavior, but produced no change in immobility time in the forced swim test. In contrast, imipramine and desipramine suppressed both marble-burying behavior and increased swimming time in the forced swim test, although desipramine mildly suppressed locomotor activity at the maximal dose. Fluvoxamine, fluoxetine, and citalopram all increased extracellular levels of cortical serotonin. Desipramine and imipramine increased extracellular dopamine levels. Fluoxetine, desipramine, and imipramine increased extracellular norepinephrine levels. Correlational analysis revealed a positive correlation between efficacy of drugs in the forced swim test and cortical extracellular dopamine levels, whereas a positive correlation was found between efficacy in the marble-burying test and extracellular serotonin levels. CONCLUSIONS: Although marble burying and forced swimming behavior have strong predictive validity in tests of antidepressant action, each assay appears to be underpinned by entirely different neurochemical systems.

Kv7.2-7.5 voltage-gated potassium channel (KCNQ2-5) opener, retigabine, reduces capsaicin-induced visceral pain in mice.

K(v)7.2-7.5 voltage-gated potassium channels (KCNQ2-5) are associated with M-current and known to distribute in the nociceptive sensory pathway (e.g., dorsal root ganglia and spinal cord). Opening of these channels leads to cell membrane hyperpolarization that results in decreased neuronal action potentials. Since, KCNQ/M-current is located in the visceral sensory system, we examined the anti-nociceptive effect of the KCNQ opener, retigabine, on visceral pain induced by an intracolonic injection of capsaicin in mice. Intraperitoneal administration of retigabine (1, 3 and 10 mg/kg) dose-dependently suppressed visceral pain behavior (i.e., the number of licking) induced by the capsaicin treatment and prolonged the latency to first licking. These data provide the first evidence that increased KCNQ channel conductance plays an inhibitory role in the visceral pain pathway.