Safety and efficacy of the 10-day melarsoprol schedule for the treatment of second stage rhodesiense sleeping sickness

Objective

Assessment of the safety and efficacy of a 10-day melarsoprol schedule in second stage T.b. rhodesiense patients and the effect of suramin-pretreatment on the incidence of encephalopathic syndrome (ES) during melarsoprol therapy.

Design

Sequential conduct of a proof-of-concept trial (n = 60) and a utilization study (n = 78) using historic controls as comparator.

Setting

Two trial centres in the T.b. rhodesiense endemic regions of Tanzania and Uganda. Participants: Consenting patients with confirmed second stage disease and a minimum age of 6 years were eligible for participation. Unconscious and pregnant patients were excluded.

Main Outcome Measures

The primary outcome measures were safety and efficacy at end of treatment. The secondary outcome measure was efficacy during follow-up after 3, 6 and 12 months.

Results

The incidence of ES in the trial population was 11.2% (CI 5–17%) and 13% (CI 9–17%) in the historic data. The respective case fatality rates were 8.4% (CI 3–13.8%) and 9.3% (CI 6–12.6%). All patients discharged alive were free of parasites at end of treatment. Twelve months after discharge, 96% of patients were clinically cured. The mean hospitalization time was reduced from 29 to 13 days (p<0.0001) per patient.

Conclusions

The 10-day melarsoprol schedule does not expose patients to a higher risk of ES or death than does treatment according to national schedules in current use. The efficacy of the 10-day melarsoprol schedule was highly satisfactory. No benefit could be attributed to the suramin pre-treatment.

Trial Registration

Current Controlled Trials ISRCTN40537886     

阿尔卑斯山黄花茅(Anthoxanthum alpinum)沿海拔梯度的基因频率分布

在瑞士阿尔卑斯山的2个定点样地,黄花茅从森林线（海拔1700 m）到山顶（海拔2830 m）呈连续分布。在海拔梯度样带的最高和最低定样场所间的垂直距离差不多为1000 m,但2个定样场所间相距仅仅1.4 km。在所研究的3个海拔梯度样带中,3个同工酶位点（Px_1, Got_2和 Mdh_1）被观察到有统计意义的倾群变异。研究结果显示：沿海拔梯度样带的亚居群间的基因流可能太弱不足以克服自然选择的影响,后者促使对局部环境的适应。在这种情况下,温度因子至少可能作为一种主要的自然选择力起作用。     

Transforming growth factor-beta blocks proliferation but not early mitogenic signaling events in T-lymphocytes

Transforming growth factor-beta (TGF-beta) inhibits the proliferation of T-lymphocytes in response to activation with mitogenic lectin. The influence of TGF-beta on elevation of cytosolic Ca2+, induction of proliferation-associated mRNA species, and total cellular RNA content has been studied. The cells seem to exit G0 when activated in the presence of TGF-beta, but they arrest in mid-G1 phase.     

阿尔卑斯山高山-亚高山过渡区高山黄花茅的群体遗传结构和分化研究

应用等位酶分析,在瑞士阿尔卑斯山的阿尔拜特(Arpette)和拜阿尔普(Belalp),沿三个不同的海拔梯度,研究了高山黄花茅3个自然居群的遗传变异和分化。研究结果表明,平均的多态性位点比例为64．9％,每个位点平均等位基因数为2．37,平均期望杂合性为0．252。亚居群间平均的遗传距离为0．011,发现79％的遗传变异存在于居群内。基于等位酶分析,边缘亚居群与中心亚居群似乎有类似的遗传变异性。相对比较高的遗传分化、低的亚居群间基因流和小的邻居大小值暗示,近交和随后的遗传漂变可能是导致阿尔拜特黄花茅居群遗传变异性较低的主要原因。     

Large-scale 13C-flux analysis reveals mechanistic principles of metabolic network robustness to null mutations in yeast

Background  

Quantification of intracellular metabolite fluxes by ¹³C-tracer experiments is maturing into a routine higher-throughput analysis. The question now arises as to which mutants should be analyzed. Here we identify key experiments in a systems biology approach with a genome-scale model of Saccharomyces cerevisiae metabolism, thereby reducing the workload for experimental network analyses and functional genomics.     

Evaluation of the efficacy and safety of rivaroxaban using a computer model for blood coagulation

Rivaroxaban is an oral, direct Factor Xa inhibitor approved in the European Union and several other countries for the prevention of venous thromboembolism in adult patients undergoing elective hip or knee replacement surgery and is in advanced clinical development for the treatment of thromboembolic disorders. Its mechanism of action is antithrombin independent and differs from that of other anticoagulants, such as warfarin (a vitamin K antagonist), enoxaparin (an indirect thrombin/Factor Xa inhibitor) and dabigatran (a direct thrombin inhibitor). A blood coagulation computer model has been developed, based on several published models and preclinical and clinical data. Unlike previous models, the current model takes into account both the intrinsic and extrinsic pathways of the coagulation cascade, and possesses some unique features, including a blood flow component and a portfolio of drug action mechanisms. This study aimed to use the model to compare the mechanism of action of rivaroxaban with that of warfarin, and to evaluate the efficacy and safety of different rivaroxaban doses with other anticoagulants included in the model. Rather than reproducing known standard clinical measurements, such as the prothrombin time and activated partial thromboplastin time clotting tests, the anticoagulant benchmarking was based on a simulation of physiologically plausible clotting scenarios. Compared with warfarin, rivaroxaban showed a favourable sensitivity for tissue factor concentration inducing clotting, and a steep concentration-effect relationship, rapidly flattening towards higher inhibitor concentrations, both suggesting a broad therapeutic window. The predicted dosing window is highly accordant with the final dose recommendation based upon extensive clinical studies.     

Integrating Cellular Metabolism into a Multiscale Whole-Body Model

Cellular metabolism continuously processes an enormous range of external compounds into endogenous metabolites and is as such a key element in human physiology. The multifaceted physiological role of the metabolic network fulfilling the catalytic conversions can only be fully understood from a whole-body perspective where the causal interplay of the metabolic states of individual cells, the surrounding tissue and the whole organism are simultaneously considered. We here present an approach relying on dynamic flux balance analysis that allows the integration of metabolic networks at the cellular scale into standardized physiologically-based pharmacokinetic models at the whole-body level. To evaluate our approach we integrated a genome-scale network reconstruction of a human hepatocyte into the liver tissue of a physiologically-based pharmacokinetic model of a human adult. The resulting multiscale model was used to investigate hyperuricemia therapy, ammonia detoxification and paracetamol-induced toxication at a systems level. The specific models simultaneously integrate multiple layers of biological organization and offer mechanistic insights into pathology and medication. The approach presented may in future support a mechanistic understanding in diagnostics and drug development.     

Population genetic structure and differentiation of Anthoxanthum alpinum in the subalpine-alpine ecocline of Swiss Alps

Allozyme variation in 6 enzyme systems coding 10 loci was estimated for 18 subpopulations of Anthoxanthum alpinum from three altitudinal transects in two localities of the Swiss Alps. Mean proportions of polymorphic loci (95% criterion), average number of alleles per locus, and mean expected heterozygosity were 64.9%, 2.37 and 0. 252, respectively. Mean genetic distance among populations was 0.011, and 79% of the genetic variation resided within populations. Based on allozyme analysis, marginal subpopulations appeared to have similar level of genetic variability to central subpopulations. Relatively high genetic differentiation, low gene flow values and small neighbourhood sizes suggested that inbreeding followed by genetic drift was possible causes of lowgenetic variability in Arpette A. alpinum populations.