Effectiveness of delayed-release dimethyl fumarate on patient-reported outcomes and clinical measures in patients with relapsing-remitting multiple sclerosis in a real-world clinical setting: PROTEC.

Ensaio clínico PROTEC, Protocolo nº 109MS408Abstract BACKGROUND: Patient-reported outcomes (PRO) and clinical outcomes give a broad assessment of relapsing-remitting multiple sclerosis (RRMS) disease. OBJECTIVE: The aim is to evaluate the effectiveness of delayed-release dimethyl fumarate (DMF) on disease activity and PROs in patients with RRMS in the clinic. METHODS: PROTEC, a phase 4, open-label, 12-month observational study, assessed annualized relapse rate (ARR), proportion of patients relapsed, and changes in PROs. Newly diagnosed and early MS (≤3.5 EDSS and ≤1 relapse in the prior year) patient subgroups were evaluated. RESULTS: Unadjusted ARR at 12 months post-DMF versus 12 months before DMF initiation was 75% lower (0.161 vs. 0.643, p < 0.0001) overall (n = 1105) and 84%, 77%, and 71% lower in newly diagnosed, ≤3.5 EDSS, and ≤1 relapse subgroups, respectively. Overall, 88% of patients were relapse-free 12 months after DMF initiation (84%, newly diagnosed; 88%, ≤3.5 EDSS; 88%, ≤1 relapse). PRO measures for fatigue, treatment satisfaction, daily living, and work improved significantly over 12 months of DMF versus baseline. CONCLUSION: At 12 months after versus 12 months before DMF initiation, ARR was significantly lower, the majority of patients were relapse-free, and multiple PRO measures showed improvement (overall and for subgroups), suggesting that DMF is effective based on clinical outcomes and from a patient perspective.Clinical trial: A Study Evaluating the Effectiveness of Tecfidera (Dimethyl Fumarate) on Multiple Sclerosis (MS) Disease Activity and Patient-Reported Outcomes (PROTEC), NCT01930708,info:eu-repo/semantics/publishedVersio

Predicting the outcome of heart failure against chronic-ischemic heart disease in elderly population – Machine learning approach based on logistic regression, case to Villa Scassi hospital Genoa, Italy

Totally 167 patients were admitted at cardiology ward in Villa Scassi hospital, Genoa, Italy. We worked with two control groups: heart failure 59 patients (mean age: 71.37 ± 13.27 years) and chronic-ischemic heart disease 108 patients (mean age: 68.85 ± 11.3 years). Nine parameters: Hb, Serum Creatinine, LDL, HDL, Triglycerides, ALT, AST, hs-cTnI, CRP were evaluated onset to hospitalization. We aimed to identify significant independent predictors relative to the outcome of heart failure versus chronic-ischemic heart disease and select combination of biochemical parameters in logistic regression-based model that would provide on average excellent discrimination to the outcome of heart failure versus chronic-ischemic heart disease in elderly population. Applying 20-fold repeated stratified cross-validation, 4:1 train/test ratio split, we have found that probability of heart failure, provides best discrimination of the outcome of heart failure against chronic-ischemic heart disease

Time to redefine endometriosis including its pro-fibrotic nature

Endometriosis is currently defined as presence of endometrial epithelial and stromal cells at ectopic sites. This simple and straightforward definition has served us well since its original introduction. However, with advances in disease knowledge, endometrial stromal and glands have been shown to represent only a minor component of endometriotic lesions and they are often absent in some disease forms. In rectovaginal nodules, the glandular epithelium is often not surrounded by stroma and frequently no epithelium can be identified in the wall of ovarian endometriomas. On the other hand, a smooth muscle component and fibrosis represent consistent features of all disease forms. Based on these observations, we believe that the definition of endometriosis should be reconsidered and reworded as 'A fibrotic condition in which endometrial stroma and epithelium can be identified'. The main reasons for this change are: (1) to foster the evaluation of fibrosis in studies on endometriosis pathogenesis using animal models; (2) to limit potential false negative diagnoses if pathologists stick stringently to the current definition of endometriosis requiring the demonstration of endometrial stromal and glands; (3) to consider fibrosis as a potential target for treatment in endometriosis. This opinion article is aimed at boosting the attention paid to a largely neglected aspect of the disease. We hope that targeting the fibrotic process might increase success in developing new therapeutic approaches

Macro Asset Allocation with Social Impact Investments

Using a unique dataset of 50 listed companies that meet the majority of the OECD requirements for social impact investments, we construct a social impact finance stock index and investigate how investing in social impact firms can contribute to portfolio risk-return performance. We build portfolios with three different methodologies (naïve, Markowitz mean-variance optimization, GARCH-copula model), and we study the performance in terms of returns, Sharpe ratio, utility, and forecast premium based on a constant relative risk aversion function for investors with different levels of risk aversion. Consistent with the idea that social impact investment can improve portfolio risk-return performance, the results of our macro asset allocation analysis show the importance of a large fraction of investor portfolios’ stake committed to social impact investments

Consistent Truncation to Three Dimensional (Super-)gravity

For a general three dimensional theory of (super-)gravity coupled to arbitrary matter fields with arbitrary set of higher derivative terms in the effective action, we give an algorithm for consistently truncating the theory to a theory of pure (super-)gravity with the gravitational sector containing only Einstein-Hilbert, cosmological constant and Chern-Simons terms. We also outline the procedure for finding the parameters of the truncated theory. As an example we consider dimensional reduction on S^2 of the 5-dimensional minimal supergravity with curvature squared terms and obtain the truncated theory without any curvature squared terms. This truncated theory reproduces correctly the exact central charge of the boundary CFT.Comment: LaTeX file, 22 page

Molecular interaction of BMP-4, TGF-β, and estrogens in lactotrophs: Impact on the PRL promoter

The regulatory role of estrogen, bone morphogenetic protein-4 (BMP-4), and TGF-β has a strong impact on hormone secretion, gene transcription, and cellular growth of prolactin (PRL)-producing cells. In contrast to TGF-β, BMP-4 induces the secretion of PRL in GH3 cells. Therefore, we studied the mechanism of their transcriptional regulation. Both BMP-4 and TGF-β inhibited the transcriptional activity of the estrogen receptor (ER). Estrogens had no effect on TGF-β-specific Smad protein transcriptional activity but presented a stimulatory action on the transcriptional activity of the BMP-4-specific Smads. BMP-4/estrogen cross talk was observed both on PRL hormone secretion and on the PRL promoter. This cross talk was abolished by the expression of a dominant-negative form for Smad-1 and treatment with ICI 182780 but not by point mutagenesis of the estrogen response element site within the promoter, suggesting that Smad/ER interaction might be dependent on the ER and a Smad binding element. By serial deletions of the PRL promoter, we observed that indeed a region responsive to BMP-4 is located between -2000 and -1500 bp upstream of the transcriptional start site. Chromatin immunoprecipitation confirmed Smad-4 binding to this region, and by specific mutation and gel shift assay, a Smad binding element responsible site was characterized. These results demonstrate that the different transcriptional factors involved in the Smad/ER complexes regulate their transcriptional activity in differential ways and may account for the different regulatory roles of BMP-4, TGF-β, and estrogens in PRL-producing cells. Copyright © 2009 by The Endocrine Society.Fil:Giacomini, D. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina.Fil:Páez-Pereda, M. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina

Diltiazem downregulates IL-12 production by human dendritic cells

It is well known that IL-12 plays a central role in the initiation and control of allogeneic immune response. It promotes the proliferation of lymphocytes and NK cells, cytotoxic activity of NK cells, and CTL. It was recently shown that IL-12 is involved in the regulation of T helper Th1-Th2 responses by exerting stimulatory effects on Th1 and inhibitory effects on Th2. This regulatory role is believed to result from the ability of IL-12 to induce IFN-γ production in activated T cells and NK cells.[1 and 2] Th1 cytokines (IL-2 and IFN-γ) promote both CTL and delayed-type hypersensitivity (DTH) responses, which are considered the principal effector mechanisms of allograft rejection. Diltiazem, a calcium channel blocker used in organ transplantation, is often included in clinical protocols in association with cyclosporin A and corticosteroids.[3] It was used initially because of its antinephrotoxic and antihypertensive effects, so that the undesirable side effects induced by immunosuppressive therapy could be reduced. We previously studied the effect of diltiazem on human mixed lymphocyte reactions (MLR) and on isolated human monocytes, showing the capacity of this drug to affect proinflammatory cytokine production.[4 and 5] Since dendritic cells (DCs) are the most effective antigen-presenting cells (APCs) to prime naive T cells, we were interested in determining the influence of diltiazem on human DCs. Human DCs generated from peripheral blood monocytes in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) have been characterised as immature DCs. To become fully potent APCs, DCs must undergo maturation induced either by a proinflammatory signal such as lipopolysaccharide (LPS) or by interaction with CD40L expressed on activated T lymphocytes. [6] The ability of mature DCs to act as potent APCs is due to their high expression of MHC and costimulatory molecules and also to their production of cytokines, especially IL-12. Therefore, we determined the effect of diltiazem on cytokine production by human DCs with a particular interest in IL-1β, IL-6, TNF-α, and IL-12 production