Safety of switching between rituximab biosimilars in onco-hematology.

Comparable clinical efficacy and safety of the reference rituximab (MABTHERA) and its biosimilars has been established in randomized trials. However, safety concerns are often raised when switching from reference to biosimilar products and between different biosimilars. In this prospective observational study we aimed at evaluating the safety of switching between reference and biosimilar rituximab (TRUXIMA and RIXATHON) at Trento General Hospital (Italy). All patients (n = 83) with Non Hodgkin's Lymphoma (NHL, n = 72) and Chronic Lymphocytic Leukemia (CLL, n = 11) who received rituximab between March 2018 and March 2019 were asked to take part in the study. In 2017 and 2018 two tenders were carried out and two different biosimilars became available in the hospital, these were used sequentially. Thus, patients with or without previous treatments with the originator rituximab either received a biosimilar or were switched between different biosimilars. The incidence of adverse events in these groups of patients is described. The study population received 465 rituximab infusions and all received biosimilars. Fifty patients (60%) experienced at least one switch between different biosimilars or between rituximab originator and biosimilar, whereas 33 (40%) received one of the two biosimilars and one patient received reference rituximab. Adverse events (n = 146) were reported in 71 patients (84.5%). Treatment-related grade 3-4 events were reported in 5 patients (5.9%), whereas grade 1 rituximab related infusion events were observed in 6 patients (7.1%). No safety signal emerged in association with the use of a specific biosimilar nor with the practice of switching. Adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of rituximab biosimilars.

Kidney size in relation to ageing, gender, renal function, birthweight and chronic kidney disease risk factors in a general population.

BACKGROUND: The relationship of kidney size to ageing, kidney function and kidney disease risk factors is not fully understood. METHODS: Ultrasound length and parenchymal kidney volume were determined from a population-based sample of 3972 Sardinians (age range 18-100 years). We then identified the subset of 2256 'healthy' subjects to define age- and sex-specific reference ranges (2.5-97.5 percentile) of kidney volume. Logistic regression (accounting for family clustering) was used to identify the clinical characteristics associated with abnormally large kidneys or abnormally small kidneys. RESULTS: In the healthy subset, kidney volume and length increased up to the fourth to fifth decade of life followed by a progressive decrease in men, whereas there was a gradual kidney volume decrease throughout the lifespan of women. In the whole sample, independent predictors of lower kidney volume (<2.5 percentile for age and sex) were male sex, low body mass index, short height, low waist:hip ratio and high serum creatinine (SCr); the independent predictors of larger kidney volume (>97.5 percentile for age and sex) were younger age, female sex, diabetes, obesity, high height, high waist:hip ratio and lower SCr. Estimated heritability for kidney volume was 15%, and for length 27%; kidney volume correlated strongly with birthweight. CONCLUSIONS: Overall, in a general healthy population, kidney measures declined with age differently in men and women. The determinants of kidney parenchymal volume include genetic factors and modifiable clinical factors.

Genetic variants regulating immune cell levels in health and disease.

The complex network of specialized cells and molecules in the immune system has evolved to defend against pathogens, but inadvertent immune system attacks on "self" result in autoimmune disease. Both genetic regulation of immune cell levels and their relationships with autoimmunity are largely undetermined. Here, we report genetic contributions to quantitative levels of 95 cell types encompassing 272 immune traits, in a cohort of 1,629 individuals from four clustered Sardinian villages. We first estimated trait heritability, showing that it can be substantial, accounting for up to 87% of the variance (mean 41%). Next, by assessing ∼8.2 million variants that we identified and confirmed in an extended set of 2,870 individuals, 23 independent variants at 13 loci associated with at least one trait. Notably, variants at three loci (HLA, IL2RA, and SH2B3/ATXN2) overlap with known autoimmune disease associations. These results connect specific cellular phenotypes to specific genetic variants, helping to explicate their involvement in disease.

A new fluorogenic peptide determines proteasome activity in single cells.

The ubiquitin-proteasome system plays a critical role in many diseases, making it an attractive biomarker and therapeutic target. However, the impact of results obtained in vitro using purified proteasome particles or whole cell extracts is limited by the lack of efficient methods to assess proteasome activity in living cells. We have engineered an internally quenched fluorogenic peptide with a proteasome-specific cleavage motif fused to TAT and linked to the fluorophores DABCYL and EDANS. This peptide penetrates cell membranes and is rapidly cleaved by the proteasomal chymotrypsin-like activity, generating a quantitative fluorescent reporter of in vivo proteasome activity as assessed by time-lapse or flow cytometry fluorescence analysis. This reporter is an innovative tool for monitoring proteasomal proteolytic activities in physiological and pathological conditions.

Formation of 2-substituted benzofuran fragment ions from 6-alkyl- and 6-aryldibenzo(d,f)(1,3)dioxepine derivatives under electron ionization-a useful precursor ion for isomeric differentiation.

Tandem mass spectrometry has been applied to differentiate three sets of o-, m- and p-methyl, -methoxy and -nitro-substituted-6-phenyl-dibenzo(d,f)(1,3)dioxepines. Collision-induced dissociation (CID) experiments have been carried out on 2-phenylbenzo[b]furan fragment ions, which originate from the decomposition of the molecular ions after their EI-induced isomerization to spirocyclic structures. With the exception of m- and p-methylphenylbenzo[b]furan isomers, which display identical CID mass spectra, the three isomeric methoxy- and nitrophenylbenzo[b]furan fragment ions display very characteristic CID behavior which allows unequivocal differentiation of the 6-phenyl-dibenzo(d,f)(1,3)dioxepine isomers. 6-(o-nitrophenyl)-dibenzo(d,f)(1,3)dioxepine isomer, does not form a 2-(o-nitrophenyl)benzo[b]furan ion and, therefore, it can be differentiated from the m- and p- isomers based on the mere EI mass spectra. Furthermore, it shows a characteristic ion most likely due to an ortho effect between the nitro group and the dioxepine ring. Multiple stage mass spectrometric techniques (MSn), labeled derivatives and reference compounds were used in order to gain additional information on the structures of product ion from the CID fragmentation.

2-substituted benzofuran fragment ion formation in the electron ionization mass spectra of 6-alkyl- and 6-aryldibenzo(d,f)(1,3)dioxepine derivatives. 1. Spirocyclization of the molecular ions in the gas phase.

The formation of 2-substituted benzo[b]furan ions in the electron ionization (EI) mass spectra of a series of 6-alkyl- and 6-aryldibenzo(d,f)(1,3)dioxepines has been studied by means of exact mass measurements and multiple-stage mass spectrometry conditions using an ion trap mass spectrometer. The proposed mechanism of formation of benzo[b]furan ions requires the formation of a spirocyclic cyclohexadienone system, which undergoes elimination of a cyclopentadienone molecule. A parallel with the chemical conversion of arylmethyl-substituted dibenzo(d,f)(1,3)dioxepines into an analogous spirocyclic system was also underlined.