Modeling the Frozen-In Anticyclone in the 2005 Arctic Summer Stratosphere

Immediately following the breakup of the 2005 Arctic spring stratospheric vortex, a tropical air mass, characterized by low potential vorticity (PV) and high nitrous oxide (N2O), was advected poleward and became trapped in the easterly summer polar vortex. This feature, known as a "Frozen-In Anticyclone (FrIAC)", was observed in Earth Observing System (EOS) Aura Microwave Limb Sounder (MLS) data to span the potential temperature range from approximately 580 to 1100 K (approximately 25 to 40 km altitude) and to persist from late March to late August 2005. This study compares MLS N2O observations with simulations from the Global Modeling Initiative (GMI) chemistry and transport model, the GEOS-5/MERRA Replay model, and the VanLeer Icosahedral Triangular Advection isentropic transport model to elucidate the processes involved in the lifecycle of the FrIAC which is here divided into three distinct phases. During the "spin-up phase" (March to early April), strong poleward flow resulted in a tight isolated anticyclonic vortex at approximately 70-90 deg N, marked with elevated N2O. GMI, Replay, and VITA all reliably simulted the spin-up of the FrIAC, although the GMI and Replay peak N2O values were too low. The FrIAC became trapped in the developing summer easterly flow and circulated around the polar region during the "anticyclonic phase" (early April to the end of May). During this phase, the FrIAC crossed directly over the pole between the 7th and 14th of April. The VITA and Replay simulations transported the N2O anomaly intact during this crossing, in agreement with MLS, but unrealistic dispersion of the anomaly occurred in the GMI simulation due to excessive numerical mixing of the polar cap. The vortex associated with the FrIAC was apparently resistant to the weak vertical hear during the anticyclonic phase, and it thereby protected the embedded N20 anomaly from stretching. The vortex decayed in late May due to diabatic processes, leaving the N2O anomaly exposed to horizontal and vertical wind shears during the "shearing phase" (June to August). The observed lifetime of the FrIAC during this phase is consistent with time-scales calculated from the ambient horizontal and vertical wind shear. Replay maintained the horizontal structure of the N2O anomaly similar to NILS well into August. The VITA simulation also captured the horizontal structure of the FrIAC during this phase, but VITA eventually developed fine-scale N2O structure not observed in MLS data

SMA CARNI-VAL TRIAL PART II: A Prospective, Single-Armed Trial of L-Carnitine and Valproic Acid in Ambulatory Children with Spinal Muscular Atrophy

Multiple lines of evidence have suggested that valproic acid (VPA) might benefit patients with spinal muscular atrophy (SMA). The SMA CARNIVAL TRIAL was a two part prospective trial to evaluate oral VPA and l-carnitine in SMA children. Part 1 targeted non-ambulatory children ages 2–8 in a 12 month cross over design. We report here Part 2, a twelve month prospective, open-label trial of VPA and L-carnitine in ambulatory SMA children.This study involved 33 genetically proven type 3 SMA subjects ages 3–17 years. Subjects underwent two baseline assessments over 4–6 weeks and then were placed on VPA and L-carnitine for 12 months. Assessments were performed at baseline, 3, 6 and 12 months. Primary outcomes included safety, adverse events and the change at 6 and 12 months in motor function assessed using the Modified Hammersmith Functional Motor Scale Extend (MHFMS-Extend), timed motor tests and fine motor modules. Secondary outcomes included changes in ulnar compound muscle action potential amplitudes (CMAP), handheld dynamometry, pulmonary function, and Pediatric Quality of Life Inventory scores.Twenty-eight subjects completed the study. VPA and carnitine were generally well tolerated. Although adverse events occurred in 85% of subjects, they were usually mild and transient. Weight gain of 20% above body weight occurred in 17% of subjects. There was no significant change in any primary outcome at six or 12 months. Some pulmonary function measures showed improvement at one year as expected with normal growth. CMAP significantly improved suggesting a modest biologic effect not clinically meaningful.This study, coupled with the CARNIVAL Part 1 study, indicate that VPA is not effective in improving strength or function in SMA children. The outcomes used in this study are feasible and reliable, and can be employed in future trials in SMA

Diagnosis and management of spinal muscular atrophy : Part 1: Recommendations for diagnosis, rehabilitation, orthopedic and nutritional care

Spinal muscular atrophy (SMA) is a severe neuromuscular disorder due to a defect in the survival motor neuron 1 (SMN1) gene. Its incidence is approximately 1 in 11,000 live births. In 2007, an International Conference on the Standard of Care for SMA published a consensus statement on SMA standard of care that has been widely used throughout the world. Here we report a two-part update of the topics covered in the previous recommendations. In part 1 we present the methods used to achieve these recommendations, and an update on diagnosis, rehabilitation, orthopedic and spinal management; and nutritional, swallowing and gastrointestinal management. Pulmonary management, acute care, other organ involvement, ethical issues, medications, and the impact of new treatments for SMA are discussed in part 2

Candidate Proteins, Metabolites and Transcripts in the Biomarkers for Spinal Muscular Atrophy (BforSMA) Clinical Study

Spinal Muscular Atrophy (SMA) is a neurodegenerative motor neuron disorder resulting from a homozygous mutation of the survival of motor neuron 1 (SMN1) gene. The gene product, SMN protein, functions in RNA biosynthesis in all tissues. In humans, a nearly identical gene, SMN2, rescues an otherwise lethal phenotype by producing a small amount of full-length SMN protein. SMN2 copy number inversely correlates with disease severity. Identifying other novel biomarkers could inform clinical trial design and identify novel therapeutic targets.To identify novel candidate biomarkers associated with disease severity in SMA using unbiased proteomic, metabolomic and transcriptomic approaches.A cross-sectional single evaluation was performed in 108 children with genetically confirmed SMA, aged 2-12 years, manifesting a broad range of disease severity and selected to distinguish factors associated with SMA type and present functional ability independent of age. Blood and urine specimens from these and 22 age-matched healthy controls were interrogated using proteomic, metabolomic and transcriptomic discovery platforms. Analyte associations were evaluated against a primary measure of disease severity, the Modified Hammersmith Functional Motor Scale (MHFMS) and to a number of secondary clinical measures.A total of 200 candidate biomarkers correlate with MHFMS scores: 97 plasma proteins, 59 plasma metabolites (9 amino acids, 10 free fatty acids, 12 lipids and 28 GC/MS metabolites) and 44 urine metabolites. No transcripts correlated with MHFMS.In this cross-sectional study, "BforSMA" (Biomarkers for SMA), candidate protein and metabolite markers were identified. No transcript biomarker candidates were identified. Additional mining of this rich dataset may yield important insights into relevant SMA-related pathophysiology and biological network associations. Additional prospective studies are needed to confirm these findings, demonstrate sensitivity to change with disease progression, and assess potential impact on clinical trial design.Clinicaltrials.gov NCT00756821

Modeling the Frozen-In Anticyclone in the 2005 Arctic Summer Stratosphere

Immediately following the breakup of the 2005 Arctic spring stratospheric vortex, a tropical air mass, characterized by low potential vorticity (PV) and high nitrous oxide (N<sub>2</sub>O), was advected poleward and became trapped in the easterly summer polar vortex. This feature, known as a "Frozen-In Anticyclone (FrIAC)", was observed in Earth Observing System (EOS) Aura Microwave Limb Sounder (MLS) data to span the potential temperature range from ~580 to 1100 K (~25 to 40 km altitude) and to persist from late March to late August 2005. This study compares MLS N<sub>2</sub>O observations with simulations from the Global Modeling Initiative (GMI) chemistry and transport model, the GEOS-5/MERRA Replay model, and the Van Leer Icosahedral Triangular Advection (VITA) isentropic transport model to elucidate the processes involved in the lifecycle of the FrIAC, which is here divided into three distinct phases. During the "spin-up phase" (March to early April), strong poleward flow resulted in a tight isolated anticyclonic vortex at ~70–90° N, marked with elevated N<sub>2</sub>O. GMI, Replay, and VITA all reliably simulated the spin-up of the FrIAC, although the GMI and Replay peak N<sub>2</sub>O values were too low. The FrIAC became trapped in the developing summer easterly flow and circulated around the polar region during the "anticyclonic phase" (early April to the end of May). During this phase, the FrIAC crossed directly over the pole between 7 and 14 April. The VITA and Replay simulations transported the N<sub>2</sub>O anomaly intact during this crossing, in agreement with MLS, but unrealistic dispersion of the anomaly occurred in the GMI simulation due to excessive numerical mixing of the polar cap. The vortex associated with the FrIAC was apparently resistant to the weak vertical shear during the anticyclonic phase, and it thereby protected the embedded N<sub>2</sub>O anomaly from stretching. The vortex decayed in late May due to diabatic processes, leaving the N<sub>2</sub>O anomaly exposed to horizontal and vertical wind shears during the "shearing phase" (June to August). The observed lifetime of the FrIAC during this phase is consistent with timescales calculated from the ambient horizontal and vertical wind shear. Replay maintained the horizontal structure of the N<sub>2</sub>O anomaly similar to MLS well into August. Isentropic simulations using VITA also captured the horizontal structure of the FrIAC during this phase, but small-scale structures maintained by VITA are problematic and show that important mixing processes are absent from this single-level simulation

CLINICAL TRIAL OF L-CARNITINE AND VALPROIC ACID IN SPINAL MUSCULAR ATROPHY TYPE I

Introduction: The aim of this study was to determine the safety and therapeutic potential of L-carnitine and valproic acid (VPA) in infants with spinal muscular atrophy (SMA). Methods: Our investigation was an open-label phase 2 multicenter trial of L-carnitine and VPA in infants with SMA type I with retrospective comparison to an untreated, matched cohort. Primary outcomes were: safety and adverse events; secondary outcomes were survival, time to death/> 16 hours/day of ventilator support; motor outcomes; and maximum ulnar compound motor action potential amplitude. Results: A total of 245 AEs were observed in 35 of the 37 treated subjects (95%). Respiratory events accounted for 49% of all adverse events, resulting in 14 deaths. Survival was not significantly different between treated and untreated cohorts. Discussion: This trial provides evidence that, in infants with SMA type I, L-carnitine/VPA is ineffective at altering survival. The substantial proportion of infants reaching end-points within 6 months of enrollment underscores the urgent need for pre-symptomatic treatment in SMA type I

Nusinersen Versus Sham Control In Infantile-Onset Spinal Muscular Atrophy

BACKGROUND & para;& para;Spinal muscular atrophy is an autosomal recessive neuromuscular disorder that is caused by an insufficient level of survival motor neuron (SMN) protein. Nusinersen is an antisense oligonucleotide drug that modifies pre-messenger RNA splicing of the SMN2 gene and thus promotes increased production of full-length SMN protein.& para;& para;METHODS & para;& para;We conducted a randomized, double-blind, sham-controlled, phase 3 efficacy and safety trial of nusinersen in infants with spinal muscular atrophy. The primary end points were a motor-milestone response (defined according to results on the Hammersmith Infant Neurological Examination) and event-free survival (time to death or the use of permanent assisted ventilation). Secondary end points included over all survival and subgroup analyses of event-free survival according to disease duration at screening. Only the first primary end point was tested in a prespecified interim analysis. To control the overall type I error rate at 0.05, a hierarchical testing strategy was used for the second primary end point and the secondary end points in the final analysis.& para;& para;RESULTS & para;& para;In the interim analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (21 of 51 infants [41 %] vs. 0 of 27 [0%], P<0.001), and this result prompted early termination of the trial. In the final analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (37 of 73 infants [51%] vs. 0 of 37 [0%]), and the likelihood of event-free survival was higher in the nusinersen group than in the control group (hazard ratio for death or the use of permanent assisted ventilation, 0.53; P=0.005). The likelihood of overall survival was higher in the nusinersen group than in the control group (hazard ratio for death, 0.37; P=0.004), and infants with a shorter disease duration at screening were more likely than those with a longer disease duration to benefit from nusinersen. The incidence and severity of adverse events were similar in the two groups.& para;& para;CONCLUSIONS & para;& para;Among infants with spinal muscular atrophy, those who received nusinersen were more likely to be alive and have improvements in motor function than those in the control group. Early treatment may be necessary to maximize the benefit of the drug.Wo