A third generation vaccine for human visceral leishmaniasis and post kala azar dermal leishmaniasis : First-in-human trial of ChAd63-KH

BACKGROUND: Visceral leishmaniasis (VL or kala azar) is the most serious form of human leishmaniasis, responsible for over 20,000 deaths annually, and post kala azar dermal leishmaniasis (PKDL) is a stigmatizing skin condition that often occurs in patients after successful treatment for VL. Lack of effective or appropriately targeted cell mediated immunity, including CD8+ T cell responses, underlies the progression of VL and progression to PKDL, and can limit the therapeutic efficacy of anti-leishmanial drugs. Hence, in addition to the need for prophylactic vaccines against leishmaniasis, the development of therapeutic vaccines for use alone or in combined immuno-chemotherapy has been identified as an unmet clinical need. Here, we report the first clinical trial of a third-generation leishmaniasis vaccine, developed intentionally to induce Leishmania-specific CD8+ T cells. METHODS: We conducted a first-in-human dose escalation Phase I trial in 20 healthy volunteers to assess the safety, tolerability and immunogenicity of a prime-only adenoviral vaccine for human VL and PKDL. ChAd63-KH is a replication defective simian adenovirus expressing a novel synthetic gene (KH) encoding two Leishmania proteins KMP-11 and HASPB. Uniquely, the latter was engineered to reflect repeat domain polymorphisms and arrangements identified from clinical isolates. We monitored innate immune responses by whole blood RNA-Seq and antigen specific CD8+ T cell responses by IFNγ ELISPOT and intracellular flow cytometry. FINDINGS: ChAd63-KH was safe at intramuscular doses of 1x1010 and 7.5x1010 vp. Whole blood transcriptomic profiling indicated that ChAd63-KH induced innate immune responses characterized by an interferon signature and the presence of activated dendritic cells. Broad and quantitatively robust CD8+ T cell responses were induced by vaccination in 100% (20/20) of vaccinated subjects. CONCLUSION: The results of this study support the further development of ChAd63-KH as a novel third generation vaccine for VL and PKDL. TRIAL REGISTRATION: This clinical trial (LEISH1) was registered at EudraCT (2012-005596-14) and ISRCTN (07766359)

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Effect of Zener-Holloman Parameter on the Prior Austenite Grain size in a 12Cr-10Ni Precipitation-Hardenable Stainless Steel

Hot isothermal plane strain compression (PSC) tests were carried out on a 12Cr-10Ni martensitic precipitation-hardenable (PH) stainless steel, in the temperature range of 750-1050 A degrees C, to study microstructural evolution during large strain deformation. The nature of stress-strain curves varies with Zener-Holloman parameter (Z) with specimens deformed at high Z showing steady-state behavior and those deformed at lower Z showing flow softening. Prior austenite grain size (PAGS), d, exhibited a strong correlation to Z showing a bilinear behavior represented as: d = (1803.9)Z (-0.094) for high Z deformation and d = (1456.2)Z (-0.058) for low Z deformation. Based on the above study, it is recommended to thermomechanically process 12Cr-10Ni steel at Z ae 10(22) for obtaining products with good strength-toughness balance

Optimization of hot workability and microstructure control in a 12Cr-10Ni precipitation hardenable stainless steel: An approach using processing maps

Optimization of hot working parameters and corresponding microstructure control were explored in a 12Cr-10Ni precipitation hardenable martensitic stainless steel. From hot compression tests, 1073-1373 K (800 degrees-1100 degrees C) and five (0.001-10 s(-1)) different strain rates, processing maps were developed, and various domains of microstructure evolution (in the austenite phase) were identified. The stable domain of the processing maps appeared to indicate dynamic recrystallization (DRx) in the austenite phase: as evident by the appearance of inflection point in the strain hardening rate versus flow stress plots. The suspected DRx domain was further confirmed by detailed microstructural investigations of the respective water-quenched specimens. The DRx domain showed a refinement of the martensite packet size and of the prior transformation austenite grain size. The later was shown with optical microstructure and reconstructed (modelled) microtexture data of the prior austenite grains. Additionally, the DRx domain showed a significant difference in activation energy as estimated from appropriate constitutive modelling