The immunogenicity to the first anti-TNF therapy determines the outcome of switching to a second anti-TNF therapy in spondyloarthritis patients

Introduction

Anti-TNF drugs have proven to be effective against spondyloarthritis (SpA), although 30% of patients fail to respond or experience adverse events leading to treatment discontinuation. In rheumatoid arthritis, the presence of anti-drug antibodies (ADA) against the first TNF inhibitor influences the outcome after switching. Our aim was to assess whether the response to a second anti-TNF drug is related to the previous development of ADA to the first anti-TNF drug SpA patients.

Methods

Forty-two SpA patients began a second anti-TNF drug after failing to respond to the first anti-TNF therapy. Clinical activity was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) at baseline (at the beginning of the first and second anti-TNF therapy) and at 6 months after switching. The drug and ADA levels were measured by ELISA before each administration.

Results

All patients were treated with anti-TNF drugs and mainly due to inefficacy were switched to a second anti-TNF drug. Eleven of 42 (26.2%) developed ADA during the first biologic treatment. At baseline, no differences in ASDAS were found in patients with or without ADA to the first anti-TNF drug (3.52 ± 1.03 without ADA vs. 3.14 ± 0.95 with ADA, p = 0.399) and to the second anti-TNF drug (3.36 ± 0.94 without ADA vs. 3.09 ± 0.91 with ADA, p = 0.466). At 6 months after switching, patients with previous ADA had lower disease activity (1.62 ± 0.93 with ADA vs. 2.79 ± 1.01 without ADA, p = 0.002) and most patients without ADA had high disease activity state by the ASDAS (25 out of 31 (80.6%) without ADA vs. 3 out of 11 (27.3%) with ADA, p = 0.002).

Conclusions

In SpA the failure to respond to the first anti-TNF drug due to the presence of ADA predicts a better clinical response to a second anti-TNF drug.     

Volumetric-modulated arc therapy with RapidArc®: An evaluation of treatment delivery efficiency

Aim/background

To evaluate how the use of volumetric-modulated arc therapy (VMAT) with RapidArc^® can improve treatment delivery efficiency based on the analysis of the beam-on times and monitor units (MU) needed to deliver therapy for multiple clinical applications in a large patient population.

Materials and methods

A total of 898 treatment courses were delivered in 745 patients treated from October 2008 to March 2013 using RapidArc® treatment plans generated in Eclipse™ TPS. All patients were treated with curative or palliative intent using different techniques including conventional fractionation (83%) and radiosurgery or SBRT (17%), depending on the clinical indications. Treatment delivery was evaluated based on measured beam-on time and recorded MU values delivered on a Varian Trilogy™ linear accelerator.

Results

For conventional fractionation treatments using RapidArc®, the delivery times ranged from 38 s to 4 min and 40 s (average 2 min and 6 s). For radiosurgical treatments the delivery times ranged from 1 min and 42 s to 9 min and 22 s (average 4 min and 4 s). The average number of MU per Gy was 301 for the entire group, with 285 for the conventional group and 317 for the radiosurgical group.

Conclusions

In this study with a large heterogeneous population, treatments using RapidArc® were delivered with substantially less beam-on time and fewer MUs than conventional fractionation. This was highly advantageous, increasing flexibility of the scheduling allowing treatment of radiosurgery patients during the regular daily work schedule. Additionally, reduction of leakage radiation dose was achieved.     

Systematics of Old World Odontacolus Kieffer s.l. (Hymenoptera,Platygastridae s.l.): parasitoids?of?spider?eggs

The genera Odontacolus Kieffer and Cyphacolus Priesner are among the most distinctive platygastroid wasps because of their laterally compressed metasomal horn; however, their generic status has remained unclear. We present a morphological phylogenetic analysis comprising all 38 Old World and four Neotropical Odontacolus species and 13 Cyphacolus species, which demonstrates that the latter is monophyletic but nested within a somewhat poorly resolved Odontacolus. Based on these results Cyphacolus syn. n. is placed as a junior synonym of Odontacolus which is here redefined. The taxonomy of Old World Odontacolus s.str. is revised; the previously known species Odontacolus longiceps Kieffer (Seychelles), Odontacolus markadicus Veenakumari (India), Odontacolus spinosus (Dodd) (Australia) and Odontacolus hackeri (Dodd) (Australia) are re-described, and 32 new species are described: Odontacolus africanus Valerio & Austin sp. n. (Congo, Guinea, Kenya, Madagascar, Mozambique, South Africa, Uganda, Zimbabwe), Odontacolus aldrovandii Valerio & Austin sp. n. (Nepal), Odontacolus anningae Valerio & Austin sp. n. (Cameroon), Odontacolus australiensis Valerio & Austin sp. n. (Australia), Odontacolus baeri Valerio & Austin sp. n. (Australia), Odontacolus berryae Valerio & Austin sp. n. (Australia, New Zealand, Norfolk Island), Odontacolus bosei Valerio & Austin sp. n. (India, Malaysia, Sri Lanka), Odontacolus cardaleae Valerio & Austin sp. n. (Australia), Odontacolus darwini Valerio & Austin sp. n. (Thailand), Odontacolus dayi Valerio & Austin sp. n. (Indonesia), Odontacolus gallowayi Valerio & Austin sp. n. (Australia), Odontacolus gentingensis Valerio & Austin sp. n. (Malaysia), Odontacolus guineensis Valerio & Austin sp. n. (Guinea), Odontacolus harveyi Valerio & Austin sp. n. (Australia), Odontacolus heratyi Valerio & Austin sp. n. (Fiji), Odontacolus heydoni Valerio & Austin sp. n. (Malaysia, Thailand), Odontacolus irwini Valerio & Austin sp. n. (Fiji), Odontacolus jacksonae Valerio & Austin sp. n. (Cameroon, Guinea, Madagascar), Odontacolus kiau Valerio & Austin sp. n. (Papua New Guinea), Odontacolus lamarcki Valerio & Austin sp. n. (Thailand), Odontacolus madagascarensis Valerio & Austin sp. n. (Madagascar), Odontacolus mayri Valerio & Austin sp. n. (Indonesia, Thailand), Odontacolus mot Valerio & Austin sp. n. (India), Odontacolus noyesi Valerio & Austin sp. n. (India, Indonesia), Odontacolus pintoi Valerio & Austin sp. n. (Australia, New Zealand, Norfolk Island), Odontacolus schlingeri Valerio & Austin sp. n. (Fiji), Odontacolus sharkeyi Valerio & Austin sp. n. (Thailand), Odontacolus veroae Valerio & Austin sp. n. (Fiji), Odontacolus wallacei Valerio & Austin sp. n. (Australia, Indonesia, Malawi, Papua New Guinea), Odontacolus whitfieldi Valerio & Austin sp. n. (China, India, Indonesia, Sulawesi, Malaysia, Thailand, Vietnam), Odontacolus zborowskii Valerio & Austin sp. n. (Australia), and Odontacolus zimi Valerio & Austin sp. n. (Madagascar). In addition, all species of Cyphacolus are here transferred to Odontacolus: Odontacolus asheri (Valerio, Masner & Austin) comb. n. (Sri Lanka), Odontacolus axfordi (Valerio, Masner & Austin) comb. n. (Australia), Odontacolus bhowaliensis (Mani & Mukerjee) comb. n. (India), Odontacolus bouceki (Austin & Iqbal) comb. n. (Australia), Odontacolus copelandi (Valerio, Masner & Austin) comb. n. (Kenya, Nigeria, Zimbabwe, Thailand), Odontacolus diazae (Valerio, Masner & Austin) comb. n. (Kenya), Odontacolus harteni (Valerio, Masner & Austin) comb. n. (Yemen, Ivory Coast, Paskistan), Odontacolus jenningsi (Valerio, Masner & Austin) comb. n. (Australia), Odontacolus leblanci (Valerio, Masner & Austin) comb. n. (Guinea), Odontacolus lucianae (Valerio, Masner & Austin) comb. n. (Ivory Coast, Madagascar, South Africa, Swaziland, Zimbabwe), Odontacolus normani (Valerio, Masner & Austin) comb. n. (India, United Arab Emirates), Odontacolus sallyae (Valerio, Masner & Austin) comb. n. (Australia), Odontacolus tessae (Valerio, Masner & Austin) comb. n. (Australia), Odontacolus tullyae (Valerio, Masner & Austin) comb. n. (Australia), Odontacolus veniprivus (Priesner) comb. n. (Egypt), and Odontacolus watshami (Valerio, Masner & Austin) comb. n. (Africa, Madagascar). Two species of Odontacolus are transferred to the genus Idris Förster: Idris longispinosus (Girault) comb. n. and Idris amoenus (Kononova) comb. n., and Odontacolus doddi Austin syn. n. is placed as a junior synonym of Odontacolus spinosus (Dodd). Odontacolus markadicus, previously only known from India, is here recorded from Brunei, Malaysia, Sri Lanka, Thailand and Vietnam. The relationships, distribution and biology of Odontacolus are discussed, and a key is provided to identify all species.     

Association between the risk of coronary artery disease in South Asians and a deletion polymorphism in glutathione S-transferase M1

Background: The aim of the present study was to evaluate whether or not an elevated ischaemia-modified albumin (IMA) level provides any additional prognostic information to the validated Thrombolysis In Myocardial Infarction (TIMI) risk score in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: One hundred seven consecutive STEMI patients treated with primary PCI were included. The incidence of 30-day death was the prespecified primary end point. Serum IMA was measured immediately at hospital arrival. Results: The incidence of the primary end point was 6.5%. A significant predictive value of IMA in relation to the primary end point was indicated by an area under the ROC curve of 0.71 (p = 0.01). In the multivariate analysis, increased IMA remained a significant predictor of the primary end point after adjustment for TIMI risk predictors (p = 0.019). The area under the ROC curve for the TIMI risk score was 0.68 (p = 0.03). The addition of IMA to the TIMI risk score did not improve its prognostic value (area under the ROC curve 0.60, p = 0.25). Conclusion: IMA levels obtained at admission are a powerful indicator of short-term mortality in STEMI patients treated with primary PCI, but do not seem to be a marker that adds prognostic information to the validated STEMI TIMI risk score.     

Beta‐diversity in temperate and tropical forests reflects dissimilar mechanisms of community assembly

Site‐to‐site variation in species composition (β‐diversity) generally increases from low‐ to high‐diversity regions. Although biogeographical differences in community assembly mechanisms may explain this pattern, random sampling effects can create this pattern through differences in regional species pools. Here, we compared assembly mechanisms between spatially extensive networks of temperate and tropical forest plots with highly divergent species pools (46 vs. 607 species). After controlling for sampling effects, β‐diversity of woody plants was similar and higher than expected by chance in both forests, reflecting strong intraspecific aggregation. However, different mechanisms appeared to explain aggregation in the two forests. In the temperate forest, aggregation reflected stronger environmental correlations, suggesting an important role for species‐sorting (e.g. environmental filtering) processes, whereas in the tropics, aggregation reflected stronger spatial correlations, more likely reflecting dispersal limitation. We suggest that biogeographical differences in the relative importance of different community assembly mechanisms contribute to these striking gradients in global biodiversity.     

Diet and phylogeny shape the gut microbiota of Antarctic seals: a comparison of wild and captive animals

The gut microbiota of mammals underpins the metabolic capacity and health of the host. Our understanding of what influences the composition of this community has been limited primarily to evidence from captive and terrestrial mammals. Therefore, the gut microbiota of southern elephant seals, Mirounga leonina, and leopard seals, Hydrurga leptonyx, inhabiting Antarctica were compared with captive leopard seals. Each seal exhibited a gut microbiota dominated by four phyla: Firmicutes (41.5 ± 4.0%), Fusobacteria (25.6 ± 3.9%), Proteobacteria (17.0 ± 3.2%) and Bacteroidetes (14.1 ± 1.7%). Species, age, sex and captivity were strong drivers of the composition of the gut microbiota, which can be attributed to differences in diet, gut length and physiology and social interactions. Differences in particular prey items consumed by seal species could contribute to the observed differences in the gut microbiota. The longer gut of the southern elephant seal provides a habitat reduced in available oxygen and more suitable to members of the phyla Bacteroidetes compared with other hosts. Among wild seals, 16 ‘core’ bacterial community members were present in the gut of at least 50% of individuals. As identified between southern elephant seal mother–pup pairs, ‘core’ members are passed on via vertical transmission from a young age and persist through to adulthood. Our study suggests that these hosts have co‐evolved with their gut microbiota and core members may provide some benefit to the host, such as developing the immune system. Further evidence of their strong evolutionary history is provided with the presence of 18 shared ‘core’ members in the gut microbiota of related seals living in the Arctic. The influence of diet and other factors, particularly in captivity, influences the composition of the community considerably. This study suggests that the gut microbiota has co‐evolved with wild mammals as is evident in the shared presence of ‘core’ members.     

Inhibition of Leishmania (Leishmania) amazonensis and Rat Arginases by Green Tea EGCG, (+)-Catechin and (?)-Epicatechin: A Comparative Structural Analysis of Enzyme-Inhibitor Interactions

Epigallocatechin-3-gallate (EGCG), a dietary polyphenol (flavanol) from green tea, possesses leishmanicidal and antitrypanosomal activity. Mitochondrial damage was observed in Leishmania treated with EGCG, and it contributed to the lethal effect. However, the molecular target has not been defined. In this study, EGCG, (+)-catechin and (−)-epicatechin were tested against recombinant arginase from Leishmania amazonensis (ARG-L) and rat liver arginase (ARG-1). The compounds inhibit ARG-L and ARG-1 but are more active against the parasite enzyme. Enzyme kinetics reveal that EGCG is a mixed inhibitor of the ARG-L while (+)-catechin and (−)-epicatechin are competitive inhibitors. The most potent arginase inhibitor is (+)-catechin (IC₅₀ = 0.8 µM) followed by (−)-epicatechin (IC₅₀ = 1.8 µM), gallic acid (IC₅₀ = 2.2 µM) and EGCG (IC₅₀ = 3.8 µM). Docking analyses showed different modes of interaction of the compounds with the active sites of ARG-L and ARG-1. Due to the low IC₅₀ values obtained for ARG-L, flavanols can be used as a supplement for leishmaniasis treatment.