Inhibition of IL-6 in the treatment of fibrous dysplasia of bone: The randomized double-blind placebo-controlled TOCIDYS trial.

Increased interleukin-6 (IL-6) has been observed in the bone tissue of fibrous dysplasia of bone/McCune-Albright syndrome (FD/MAS) and is possibly involved in the increased bone destruction and bone pain characterizing this disease. The TOCIDYS trial was a randomized, placebo-controlled, 1 year, cross-over, proof-of-concept trial, conducted in patients not responding to bisphosphonates, using monthly intra-venous tocilizumab (a monoclonal antibody to the IL-6 receptor) at 8 mg/kg or a matching placebo for 6 months. Over the following 6 months, they received tocilizumab if they first had placebo, and vice-versa. We measured change in serum CTX after 6 months of treatment, compared with baseline (primary endpoint). Other endpoints were the change in bone pain, change in P1NP, bone alkaline phosphatase, osteocalcin and ICTP, and variation of quality of life. The analysis relied on ANOVA, with sequence of treatment, period and treatment as factors and accounting for a potential carry-over effect. We have randomized 8 patients with FD/MAS in each sequence who all completed the first 6 months treatment period. During the second 6 months period, 3 patients stopped therapy, so the efficacy analysis set included 13 patients. We observed no significant change in serum CTX and other biochemical markers of bone turnover between the tocilizumab and placebo groups. There was no significant change in the level of bone pain on tocilizumab, although 3 patients had a sharp decrease in pain while on active drug, with progressive relapse on placebo for 2 of them, but with some degree of improvement in a few patients while on placebo. The SF-36 quality of life scale was not significantly changed. We conclude that tocilizumab does not decrease bone turnover in FD/MAS when administered in patients who fail to respond to bisphosphonates. Tocilizumab does not reduce bone pain in most patients, but a substantial effect in a subset cannot be ruled out in this trial powered for markers but not for pain.

A theoretical study of cohesion, structural deformation, inclusion, and dynamics in porous hydrogen-bonded molecular networks.

Molecules with multiple sites of hydrogen bonding attached to suitable cores tend to crystallize as open networks. The resulting crystals can have the following unusual properties: They can include significant amounts of guest molecules; the guests are typically located in channels and can be exchanged without loss of crystallinity; and the geometry of the networks can change in response to new guests. We have found that DFT calculations can provide accurate simulations of the unusual structure and properties of such materials, represented by crystals of prototypic tetrapyridinone 1. These calculations have yielded three key insights that cannot be obtained directly from experiments. (1) The hypothetical porous network obtained by removing guests from crystals of compound 1 is highly flexible, and its deformations are inherently anisotropic, leading to lengthening or shortening of the channels along the c axis and no significant changes along the a and b axes. (2) Quantitative analysis of the total cohesive energy has revealed that hydrogen bonding within the network makes a dominant contribution, along with interactions of guests with the network. (3) Differences in the overall stability of crystals of compound 1 as the guests are varied do not arise primarily from significant changes in the cohesive energy of the network itself; instead, differences in guest-guest interactions play a key role, resulting from the nature of the guests and constraints imposed by the surrounding network. These insights, together with the results of ab initio molecular dynamics, help explain how hydrogen-bonded networks can be robust yet permit molecular movement that underlies the exchange of guests and adaptive porosity. These insights promise to be of general value to scientists studying ordered molecular materials in which strong directional interactions are prominent.