Stents With Torsional Strength for Superficial Femoral Artery Disease:: The Prospective Q3-Registry

Purpose: This postmarketing surveillance study aimed to assess effectiveness and safety of a peripheral self-expanding stent with high torsional strength (POLARIS stent) for the treatment of de novo superficial femoral artery (SFA) lesions in the routine clinical practice. Materials and Methods: Consecutive patients with symptomatic de novo SFA occlusive disease who underwent POLARIS stent implantation were enrolled into the prospective, multicenter, observational postmarket surveillance study. Primary outcome measure was freedom from clinically driven target lesion revascularization (cdTLR) at 12 months. Main secondary outcomes were procedural success, primary clinical improvement, and freedom from major adverse cardiovascular and limb events (MACLE) throughout 24 months. Results: A total of 199 participants (70±11 years, 70.4% men) were included in the study at 9 German sites from December 2014 to August 2018. Half of them (52.6%) were current smokers, 37.6% had diabetes, and 25.0% were obese. Most participants suffered from intermittent claudication (88.4%). Mean lesion length was 98±83 mm, 43.5% of lesions were occluded, and 27.3% were severely calcified. Freedom from 12 months cdTLR was 94.4% (95% confidence interval [CI], 90.6–98.2). At 24 months, freedom from cdTLR was 88.7% (95% CI, 83.0–94.4). Procedural success was achieved in 96.2% of participants. Primary clinical improvement occurred in 87.5% and 85.4% of participants at 12 and 24 months, respectively. Freedom from MACLE was 94.8% (95% CI, 91.4–98.1) and 93.8% (95% CI, 89.9–97.6) at 12 and 24 months, respectively. Conclusions: Treatment of SFA occlusive disease in a real-world setting using the POLARIS stent with high bidirectional torsional strength is efficacious and does not raise any safety concern in the medium term. The study is registered with ClinicalTrials.gov (Identifier: NCT02307292)

Induction of tolerogenic lung CD4+ T cells by local treatment with a pSTAT-3 and pSTAT-5 inhibitor ameliorated experimental allergic asthma

Signal transducer and activator of transcription (STAT)-3 inhibitors play an important role in regulating immune responses. Galiellalactone (GL) is a fungal secondary metabolite known to interfere with the binding of phosphorylated signal transducer and activator of transcription (pSTAT)-3 as well of pSTAT-6 dimers to their target DNA in vitro. Intra nasal delivery of 50 μg GL into the lung of naive Balb/c mice induced FoxP3 expression locally and IL-10 production and IL-12p40 in RNA expression in the airways in vivo. In a murine model of allergic asthma, GL significantly suppressed the cardinal features of asthma, such as airway hyperresponsiveness, eosinophilia and mucus production, after sensitization and subsequent challenge with ovalbumin (OVA). These changes resulted in induction of IL-12p70 and IL-10 production by lung CD11c+ dendritic cells (DCs) accompanied by an increase of IL-3 receptor α chain and indoleamine-2,3-dioxygenase expression in these cells. Furthermore, GL inhibited IL-4 production in T-bet-deficient CD4+ T cells and down-regulated the suppressor of cytokine signaling-3 (SOCS-3), also in the absence of STAT-3 in T cells, in the lung in a murine model of asthma. In addition, we found reduced amounts of pSTAT-5 in the lung of GL-treated mice that correlated with decreased release of IL-2 by lung OVA-specific CD4+ T cells after treatment with GL in vitro also in the absence of T-bet. Thus, GL treatment in vivo and in vitro emerges as a novel therapeutic approach for allergic asthma by modulating lung DC phenotype and function resulting in a protective response via CD4+FoxP3+ regulatory T cells locall

Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial.

BACKGROUND A clear patency benefit of a drug-eluting stent (DES) over a bare metal stent (BMS) for treating peripheral artery disease of the femoropopliteal segment has not been definitively demonstrated. The EMINENT study (Trial Comparing Eluvia Versus Bare Metal Stent in Treatment of Superficial Femoral and/or Proximal Popliteal Artery) was designed to evaluate the patency of the Eluvia DES (Boston Scientific, Marlborough, MA), a polymer-coated paclitaxel-eluting stent, compared with BMS for the treatment of femoropopliteal artery lesions. METHODS EMINENT is a prospective, randomized, controlled, multicenter European study with blinded participants and outcome assessment. Patients with symptomatic peripheral artery disease (Rutherford category 2, 3, or 4) of the native superficial femoral artery or proximal popliteal artery with stenosis ≥70%, vessel diameter of 4 to 6 mm, and total lesion length of 30 to 210 mm were randomly assigned 2:1 to treatment with DES or BMS. The primary effectiveness outcome was primary patency at 12 months, defined as independent core laboratory-assessed duplex ultrasound peak systolic velocity ratio ≤2.4 in the absence of clinically driven target lesion revascularization or surgical bypass of the target lesion. Primary sustained clinical improvement was a secondary outcome defined as a decrease in Rutherford classification of ≥1 categories compared with baseline without a repeat velocity ratio ≤2.4 in the absence of clinically driven target lesion revascularization. Health-related quality of life and walking function were assessed. RESULTS A total of 775 patients were randomly assigned to treatment with DES (n=508) or commercially available BMS (n=267). Baseline clinical, demographic, and lesion characteristics were similar between the study groups. Mean lesion length was 75.6±50.3 and 72.2±47.0 mm in the DES and BMS groups, respectively. The 12-month incidence of primary patency for DES treatment (83.2% [337 of 405]) was significantly greater than for BMS (74.3% [165 of 222]; P<0.01). Incidence of primary sustained clinical improvement was greater among patients treated with the DES than among those who received a BMS (83.0% versus 76.6%; P=0.045). The health-related quality of life dimensions of mobility and pain/discomfort improved for the majority of patients in both groups (for 66.4% and 53.6% of DES-treated and for 64.2% and 58.1% of BMS-treated patients, respectively) but did not differ significantly. At 12 months, no statistical difference was observed in all-cause mortality between patients treated with the DES or BMS (2.7% [13 of 474] versus 1.1% [3 of 263]; relative risk, 2.4 [95% CI, 0.69-8.36]; P=0.15). CONCLUSIONS By demonstrating superior 1-year primary patency, the results of the EMINENT randomized study support the benefit of using a polymer-based paclitaxel-eluting stent as a first-line stent-based intervention for patients with symptomatic peripheral artery disease attributable to femoropopliteal disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02921230

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

Die Rolle des IL-2-Signalweges in einem murinen Adenokarzinom-Modell

Die Ursachen für die Entstehung von Lungentumoren sind vielseitig. Aus geschädigtem Drüsengewebe der Lunge kann sich die Tumorart des Adenokarzinoms entwickeln, welches zu den malignen Krebserkrankungen gehört und somit nach Etablierung eines Primärtumors metastasieren kann. Es wurde vielfach gezeigt, daß das Immunsystem bei der Bekämpfung eines mutierten Gewebes im fortschreitenden Verlauf des Tumorwachstums an Effektivität verliert. Die dahinter stehenden Mechanismen sind noch nicht ganz verstanden. Eine mögliche Ursache könnte eine fehlerhafte Regulation der Immunabwehr sein. Das Zytokin, welches bei dieser Regulation eine wichtige Rolle spielt, ist das Interleukin-2 (IL-2). Dieses aktiviert immunkompetente Zellen und gewährleistet deren Fortbestand während der Immunreaktion. In der vorliegenden Arbeit ist in einem murinen Modell von Bronchioadenokarzinom die Regulation von CD4+ T-Zellen durch IL-2 untersucht worden, beziehungsweise inwieweit eine Einflußnahme auf diese Regulation zur Verbesserung der Tumorabwehr beitragen kann. Die alpha-Kette des IL-2 Rezeptorkomplexes (CD25) ist neben dem Transkriptionsfaktor Foxp3 ein gängiger Marker für die Population der so genannten regulatorischen T-Zellen. Regulatorische T-Zellen treten im Tumorgewebe in erhöhtem Maße auf und inhibieren die gegen den Tumor gerichtete Effektorfunktion anderer Immunzellen. Durch intranasale Applikation eines anti-CD25 Antikörpers sollte, im speziellen bei den regulatorischen T-Zellen, das CD25 Molekül blockiert werden, um auf diese Weise die hochaffine Signalgebung zu unterbinden und die regulatorischen T-Zellen intratumoral zu depletieren. Es konnte gezeigt werden, daß die Blockade des IL-2 Rezeptors nicht zur Reduktion des Tumorwachstums beitrug. Trotz Applikation des Antikörpers waren die regulatorischen T-Zellen signifikant erhöht. Lediglich die Produktion des Zytokins Tumornekrosisfaktor-alpha (TNF-alpha) wurde durch die Zugabe des Antikörpers gesteigert, was aber keine Verbesserung der Tumorabwehr bewirkte. Als Alternative zur Blockade des IL-2 Rezeptors wurden verschiedene Dosen von rekombinantem IL-2 ebenfalls intranasal appliziert, um die T-Zell Populationen zusätzlich zu stimulieren. In diesem Fall war bei hohen Dosierungen eine Regression des Tumors zu erreichen. Die Regression ist auf eine erhöhte, durch das IL-2 aktivierte Produktion des Zytokins Interferon-gamma ( IFN-gamma) zurückzuführen. Jedoch wurde sowohl bei der Blockade des IL-2 Rezeptors, als auch bei der Stimulation durch IL-2 ersichtlich, daß im Zusammenhang mit Adenokarzinom dem Zytokin TNF-alpha eine besondere Position zugedacht werden muß. Es ist bekannt, daß TNF-alpha in verschiedenen experimentellen Tumor-Modellen unterschiedliche Funktionen besitzt. Die Deletion des TNFs, hier dargestellt mittels TNF-knockout Mäusen, hatte eine kurative Wirkung. Die TNF-knockout Mäuse wiesen fast kein Tumorwachstum auf, die CD4+ T-Zellen aus den knockout Mäusen zeigten eine im Vergleich zum Wildtyp mehrfach höhere Produktion von IFN-gamma, bei gleichzeitiger Reduktion der regulatorischen T-Zellen. Es kann vermutet werden, daß TNF-alpha in dem verwendeten Adenokarzinom-Modell eine tumorunterstützende Wirkung hat. Dahingehend wäre die Neutralisierung der TNF-Signalgebung bei zusätzlicher Stimulation mit IL-2 als wirksamer Therapieansatz in Betracht zu ziehen.The causes of the development of lung tumours are versatile. Damaged tissue of the mucous gland of the lung could develop into the cancer type of adenocarcinoma, which is a kind of malignant cancer and spreads after establishing a primary tumour by formation of metastases. In many cases it has been shown, that the immune system looses its ability to antagonise the mutated tissue in a late stage of tumour growth. The mechanisms behind this are not entirely understood yet, but a failure in the regulation of the immune response is considered a reason. A cytokine which plays an important role in this regulation is interleukine-2 (IL-2), which activates immunocompetent cells and ensures their survival during the immune response. In the present work the regulation by IL-2 especially of the CD4+ T-cells has been examined in a murine model of bronchioadenocarcinoma, taking influence on the regulation pathway to improve tumour regression respectively. Alongside the transcription factor Foxp3 the alpha-chain of the IL-2 receptor complex (CD25) is one of the common markers of the so called regulatory T cell population. In tumour tissues the level of regulatory T cells is significantly increased, inhibiting the effector function of other immune cells directed against the tumour. An anti-CD25 antibody was administered intranasally in order to block the CD25 molecule, especially on the regulatory T cells, thus abrogating the high affinity signal to achieve an intratumoural depletion. It could be demonstrated, that the blockade of the IL-2 receptor does not result in improved tumour regression. Despite the administration of anti-CD25 antibody the level of the regulatory T cells was significantly increased. Antibody administration caused an increased production of the cytokine tumour necrosis factor alpha (TNF-alpha), though this was not sufficient to improve tumour regression. In an alternative approach to the blockade of the IL-2 receptor different dosages of recombinant IL-2 were administered intranasally for additional stimulation of the T effector cells. In this case high dosages of IL-2 could indeed improve tumour regression, due to the increase of the production of the cytokine Interferon-gamma (IFN-gamma). However, the results of both blockade and stimulation with IL-2 showed that the role of TNF-alpha in the context of adenocarcinoma must be reconsidered. It is known that depending on the experimental model, TNF-alpha bears diverse functions. The deletion of TNF, represented here by the usage of TNF-knockout mice, showed a curative effect. The TNF-knockout mice barely developed tumours due to the, in comparison to the wildtype, morefold higher production of IFN-gamma by the CD4+ T cells in combination with a significantly decreased level of regulatory T cells. The findings indicate that TNF-alpha might have a supportive effect on tumour growth in the present model of adenocarcinoma. Thus, neutralization of TNF-alpha signalling under concurrent stimulation with IL-2 should be suggested for a new approach of tumour therapy

IL-28A (IFN-lambda 2) modulates lung DC function to promote Th1 immune skewing and suppress allergic airway disease

IL-28 (IFN-lambda) cytokines exhibit potent antiviral and antitumor function but their full spectrum of activities remains largely unknown. Recently, IL-28 cytokine family members were found to be profoundly down-regulated in allergic asthma. We now reveal a novel role of IL-28 cytokines in inducing type 1 immunity and protection from allergic airway disease. Treatment of wild-type mice with recombinant or adenovirally expressed IL-28A ameliorated allergic airway disease, suppressed Th2 and Th17 responses and induced IFN-gamma. Moreover, abrogation of endogenous IL-28 cytokine function in IL-28R alpha(-/-) mice exacerbated allergic airway inflammation by augmenting Th2 and Th17 responses, and IgE levels. Central to IL-28A immunoregulatory activity was its capacity to modulate lung CD11c(+) dendritic cell (DC) function to down-regulate OX40L, up-regulate IL-12p70 and promote Th1 differentiation. Consistently, IL-28A-mediated protection was absent in IFN-gamma(-/-) mice or after IL-12 neutralization and could be adoptively transferred by IL-28A-treated CD11c(+) cells. These data demonstrate a critical role of IL-28 cytokines in controlling T cell responses in vivo through the modulation of lung CD11c(+) DC function in experimental allergic asthma