Improved patient-reported outcomes in patients with psoriatic arthritis treated with abatacept: results from a phase 3 trial

Background

To explore the effect of abatacept treatment on patient-reported outcomes (PROs) in psoriatic arthritis (PsA).

Methods

Patients with PsA were randomised (1:1) to subcutaneous abatacept 125?mg weekly/placebo for 24?weeks with early escape (EE) to open-label abatacept (week 16). Adjusted mean changes from baseline to weeks 16 (all patients) and 24 (non-EE responders) in Health Assessment Questionnaire-Disability Index (HAQ-DI), Short Form-36 (SF-36; physical and mental component summary and domains), Dermatology Life Quality Index and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) were evaluated. Subpopulations were analysed by baseline C-reactive protein (CRP) level (> vs?≤?upper limit of normal [ULN]) and prior tumour necrosis factor inhibitor (TNFi) exposure. Proportions of patients reporting improvements ≥ minimal clinically important differences (MCIDs) and?≥?normative values (NVs) in HAQ-DI, SF-36 and FACIT-F (week 16 before EE) were analysed.

Results

In total population, numerically higher improvements in most PROs were reported with abatacept (n?=?213) versus placebo (n?=?211) at both time points (P?>?0.05). Higher proportions of abatacept versus placebo patients reported PRO improvements ≥ MCID and?≥?NV at week 16. At week 16, all PRO improvements were numerically greater (P?>?0.05) in patients with baseline CRP?>?ULN versus CRP?≤?ULN (all significant [95% confidence interval] for abatacept vs placebo); improvements in SF-36 component summaries and FACIT-F were greater in TNFi-naïve versus TNFi-exposed patients (abatacept > placebo). Week 24 subgroup data were difficult to interpret due to low patient numbers.

Conclusions

Abatacept treatment improved PROs in patients with PsA versus placebo, with better results in elevated baseline CRP and TNFi-naïve subpopulations.

Trial registration

ClinicalTrials.gov number, NCT01860976 (funded by Bristol-Myers Squibb); date of registration: 23 May 2013.

     

Reproductive Isolation and Genetic Variation between Two “Strains” ofBracon hebetor(Hymenoptera: Braconidae)

Bracon hebetorSay(Hymenoptera: Braconidae) is known primarily as a parasitoid of pyralid moth larvae infesting stored grain. In the 1970s, a parasitoid identified asB. hebetorwas released for control ofHeliothis/Helicoverpaspp. (Lepidoptera: Noctuidae) on the island of Barbados. Because life-history traits of this parasitoid differed from those reported forB. hebetorfrom the United States, we conducted a series of laboratory experiments to determine whether this parasitoid was (i) a population ofB. hebetorthat attacks noctuids in the field or (ii) a different species fromB. hebetor.We confirmed thatHeliothis virescens(F.) was a more suitable host for the Barbados strain than forB. hebetor.However, a stored-grain infesting pyralid,Plodia interpunctella(Hübner), was a more suitable host for the Barbados strain than wasH. virescens.Reciprocal crosses between the Barbados strain andB. hebetorshowed that the two populations were reproductively isolated. No mating was observed during a series of 30-min observations of reciprocal crosses, and the crosses produced only male offspring. Examination of each female's spermatheca confirmed that females were not fertilized. Sequence analysis of a 517-bp fragment of the mitochondrial 16S rRNA gene revealed that two populations ofB. hebetorfrom our laboratory were identical but differed in sequence by 2% from the Barbados strain. Collectively, our results indicate that the Barbados strain is a distinct species fromB. hebetor.     

Differences in larval feeding behavior correlate with altered developmental strategies in two parasitic wasps: implications for the size-fitness hypothesis

Parasitoid wasps have long been favored organisms for fundamental studies on reproductive strategies and life-history evolution. Progeny allocation models designed with parasitoids in mind assume that offspring develop by consuming most or all of the resources available from a single host, and that size is the most important factor affecting offspring fitness. Many parasitoids exhibit host usage patterns consistent with these assumptions, but our recent observations suggested that endoparasitic wasps in the family Braconidae often do not. To investigate how differences in host usage patterns might affect developmental strategies, we compared two related braconids with contrasting host usage patterns. Apanteles carpatus consumed virtually all host tissues during immature development, whereas Microplitis demolitor fed exclusively on host hemolymph and consumed a relatively small proportion of available host resources. Development time of M. demolitor was unaffected by host size, whereas development time of A. carpatus was much longer in small hosts than in large hosts. On the other hand, offspring size in M. demolitor correlated strongly with host size, but it correlated only weakly with host size in A. carpatus . Our results collectively suggest that selection has favored rapid development at the potential cost of reduced size in M. demolitor , and increased size at the potential cost of increased development time in A. carpatus . Tissue feeding appears to be more prevalent among parasitoids overall, but hemolymph feeding is the predominant pattern of host usage in several subfamilies of endoparasitic braconids. We argue that the relative importance of offspring size and development time will be influenced by host ecology and the effects of selected traits on parasitoid survival.     

Effects of a range expansion on adaptive and neutral genetic diversity in dispersal limited Hazel grouse (<Emphasis Type="Italic">Bonasa bonasia</Emphasis>) in the French Alps

Biogeographic range expansions, when related to dispersal limitation, may have counter intuitive effects on genetic diversity. At range margins the relative roles of demographic changes, connectivity and genetic diversity need to be integrated for a successful assessment of population viability. Historically the Hazel grouse (Bonasa bonasia) in France was found in the north of the French Alps and also in a disjunct population in the nearby Jura Mountains. The species has recently undergone a range expansion in a north to south axis in the Alps. Local population size estimates and migration patterns during expansion have previously been studied. In this study, we performed genotyping at neutral (microsatellite) and adaptive (MHC) genetic markers in Hazel grouse. We compared diversity and differentiation (F_ST and D_EST) at three sampling localities along the expansion axis in the French Alps and Jura, as well as at two sampling localities in Sweden, where the population has had a long-term continuous and stable distribution. Strong serial founder effects were found between the French localities, resulting in stronger isolation further south, with a relatively high neutral differentiation (pair-wise F_ST = 0.117). However, the loss of adaptive diversity MHC was slight. No adaptive differentiation (MHC D_EST = ?0.015) was observed, thus, the French localities can be considered uniform units with regard to MHC diversity, a criterion to treat populations in these localities as a management unit.     

Identification, using synthetic peptides, of the minimum amino acid sequence from the retroviral transmembrane protein p15E required for inhibition of lymphoproliferation and its similarity to gp21 of human T-lymphotropic virus types I and II.

Synthetic peptides containing portions of a highly conserved region of retroviral transmembrane proteins of human and animal retroviruses were tested for their ability to inhibit lymphoproliferation to determine the minimum amino acid sequence required. The previously reported immunosuppression mediated by the peptide CKS-17 was confirmed and further localized to a sequence of eight residues essentially identical to the sequence present in the transmembrane protein gp21 of human T-lymphotropic virus types I and II (HTLV-I and -II). To substantiate the physiological relevance of the inhibition of lymphoproliferation observed with the synthetic peptides and to relate this activity to the intact protein, we purified the Rauscher murine leukemia virus transmembrane protein p15E by immunoaffinity chromatography and report that this purified component presented in the form of protein micelles inhibited the interleukin-2-dependent proliferation of the murine T-cell line CTLL-2 in a dose-dependent manner, with a half-maximal inhibitory dose (ID50) of approximately 16 nM. In comparison, the ID50 concentration of a recombinant form of p15E required to inhibit lymphoproliferation was approximately 2.2 microM. The results reported here support the hypothesis that the transmembrane protein gp21 of HTLV-I and -II participates in the mechanism of immunosuppression previously reported for the transmembrane proteins of feline leukemia virus and other animal retroviruses. Thus, the transmembrane protein of HTLV-I, the etiological agent of adult T-cell leukemia-lymphoma, may be partially responsible for the immunocompromised clinical course of this disease that results in fatal opportunistic infections in a majority of cases.     

Variations in the carotenoid content of Chlamydomonas reinhardii throughout the cell cycle

Synchronous cultures of Chlamydomonas reinhardii have been examined for the total amounts of carotenoid and chlorophyll present throughout a 12 hrs light–4 hrs dark life cycle. Variations in the carotenoid distribution at different points within the cell cycle have been found. During the greater part of the light period all major carotenoids increased at a proportionally similar rate. However, the increases in lutein and violaxanthin preceded those in β-carotene and neoxanthin by some 2 hrs and that in loroxanthin, an algal xanthophyll, by about 3 hrs. A marked drop in total carotenoid accumulation, corresponding to similar temporary falling away in the accumulation of β-carotene, lutein and violaxanthin occurred at 9 hrs. The correspondence of this with the established drop in RNA accumulation and the break-up of the nucleolus was pointed out. Considerable redistribution among the carotenoids occurred during the dark period, notably the amount of β-carotene increased relative to the total xanthophylls. The full significance of these results can not be estimated in the absence of comparative data on related organisms.     

Structural Proteins of Mammalian Oncogenic RNA Viruses: Immunological Characterization of the p15 Polypeptide of Rauscher Murine Virus

The immunological properties of the purified 15,000-dalton protein of Rauscher murine type-C virus were analyzed by radioimmunoassay. The majority of the antigenic determinants of this protein were found to be remarkably specific to Rauscher and Friend virus and to a lesser extent to Moloney virus. Determinants reactive with other murine viruses (group-specific) or type-C viruses of other species (interspecies) were also demonstrated but were minor components of the total antigenic specificities of the protein. The results provide evidence that the antigenic properties of this protein specify the Friend-Moloney-Rauscher subgroup of type-C viruses.     

Pathogen-induced vascular gels: Ethylene as a host intermediate

A cell free culture filtrate from 6-day cultures of Fusarium oxysporum f. sp. cubense was processed to give: (1) a heterogeneous enzyme mixture, (2) purified polygalacturonase (PG), (3) partially-purified polygalacturonate lyase and (4) β-1,4-xylanase. When introduced into explanted castor bean leaves each of these preparations was able to promote the formation of vascular system-obstructing gels. Exposure of castor bean leaves to ethylene (3 ppm) also triggered gel formation. Explanted leaves produced ethylene in response to the enzyme mixture and PG. Vascular gel formation did not occur when ethylene production in response to enzymes was prevented.     

Characterization of a conserved T cell epitope in HIV-1 gp41 recognized by vaccine-induced human cytolytic T cells.

A human CTL epitope located in a region of the HIV-1 envelope protein gp41 that is highly conserved among various HIV-1 strains was identified. This epitope was recognized by CD4+ CTL clones that were induced in seronegative humans by immunization with recombinant gp160. Fusion proteins carrying portions of the HIV-1 env gene and synthetic peptides were used to localize this epitope to amino acids 584-595 of the HIV-1 BRU env sequence. Only two positions within this epitope showed variation among North American HIV-1 isolates, and the substitutions were conservative in nature. The Lys to Arg substitution at position 593 abolished recognition, probably by interfering with the peptide-MHC interactions. This epitope was recognized in association with at least one subtype of the widely distributed human class II MHC specificity DPw4, namely DPw4.2. The relatively high frequency of this allele (27.2% among Caucasians) makes it likely that a larger fraction of the population would generate a response directed at this epitope than would be the case for epitopes recognized in the context of gene products of most other class II and class I loci. Interestingly, the closely related DP beta-chain allele types 4.1 and 2.1, which differ from 4.2 by 3 and 1 amino acids, respectively, were unable to present this gp41 peptide to DPw4.2-restricted clones. Comparison of the structure of this epitope with that of other peptides recognized in the context of DPw4.2 led to the identification of a consensus sequence for DPw4.2 binding peptides. Because the gp41 CTL epitope 584-595 identified here is highly conserved and is recognized in the context of a common DP allele, it may represent an important target region for vaccine development. Our results indicate that vaccines containing this epitope may induce in a significant fraction of those immunized CTL active against at least half of all HIV-1 strains.