Influence of pharmacogenetic variability on the pharmacokinetics and toxicity of the aurora kinase inhibitor danusertib

Objectives Danusertib is a serine/threonine kinase inhibitor of multiple kinases, including aurora-A, B, and C. This explorative study aims to identify possible relationships between single nucleotide polymorphisms in genes coding for drug metabolizing enzymes and transporter proteins and clearance of danusertib, to clarify the interpatient variability in exposure. In addition, this study explores the relationship between target receptor polymorphisms and toxicity of danusertib. Methods For associations with clearance, 48 cancer patients treated in a phase I study were analyzed for ABCB1, ABCG2 and FMO3 polymorphisms. Association analyses between neutropenia and drug target receptors, including KDR, RET, FLT3, FLT4, AURKB and AURKA, were performed in 30 patients treated at recommended phase II dose-levels in three danusertib phase I or phase II trials. Results No relationships between danusertib clearance and drug metabolizing enzymes and transporter protein polymorphisms were found. Only, for the one patient with FMO3 18281AA polymorphism, a significantly higher clearance was noticed, compared to patients carrying at least 1 wild type allele. No effect of target receptor genotypes or haplotypes on neutropenia was observed. Conclusions As we did not find any major correlations between pharmacogenetic variability in the studied enzymes and transporters and pharmacokinetics nor toxicity, it is unlikely that danusertib is highly susceptible for pharmacogenetic variation. Therefore, no dosing alterations of danusertib are expected in the future, based on the polymorphisms studied. However, the relationship between FMO3 polymorphisms and clearance of danusertib warrants further research, as we could study only a small group of patients

TOSCA – first international registry to address knowledge gaps in the natural history and management of tuberous sclerosis complex

Abstract Background Tuberous sclerosis complex (TSC) is a rare, multisystem, genetic disorder with an estimated prevalence between 1/6800 and 1/15000. Although recent years have seen huge progress in understanding the pathophysiology and in the management of TSC, several questions remain unanswered. A disease registry could be an effective tool to gain more insights into TSC and thus help in the development of improved management strategies. Methods TuberOus SClerosis registry to increase disease Awareness (TOSCA) is a multicentre, international disease registry to assess manifestations, interventions, and outcomes in patients with TSC. Patients of any age diagnosed with TSC, having a documented visit for TSC within the preceding 12 months, or newly diagnosed individuals are eligible. Objectives include mapping the course of TSC manifestations and their effects on prognosis, identifying patients with rare symptoms and co-morbidities, recording interventions and their outcomes, contributing to creation of an evidence-base for disease assessment and therapy, informing further research on TSC, and evaluating the quality of life of patients with TSC. The registry includes a ‘core’ section and subsections or ‘petals’. The ‘core’ section is designed to record general information on patients’ background collected at baseline and updated annually. Subsections will be developed over time to record additional data related to specific disease manifestations and will be updated annually. The registry aimed to enrol approximately 2000 patients from about 250 sites in 31 countries. The initial enrolment period was of 24 months. A follow-up observation period of up to 5 years is planned. Results A pre-planned administrative analysis of ‘core’ data from the first 100 patients was performed to evaluate the feasibility of the registry. Results showed a high degree of accuracy of the data collection procedure. Annual interim analyses are scheduled. Results of first interim analysis will be presented subsequent to data availability in 2014. Implications The results of TOSCA will assist in filling the gaps in understanding the natural history of TSC and help in planning better management and surveillance strategies. This large-scale international registry to study TSC could serve as a model to encourage planning of similar registries for other rare diseases

Environmental photodegradation of emerging contaminants: A re-examination of the importance of triplet-sensitised processes, based on the use of 4-carboxybenzophenone as proxy for the chromophoric dissolved organic matter

International audienceThe photoreactions sensitised by the excited triplet states of chromophoric dissolved organic matter (3CDOM*) are very important in the photochemical attenuation of emerging contaminants in natural waters. Until quite recently, anthraquinone-2-sulphonate (AQ2S) was the only available CDOM proxy molecule to estimate the contaminant reaction kinetics with 3CDOM*, under steady-state irradiation conditions. Unfortunately, the AQ2S triplet state (3AQ2S*) is considerably more reactive than average 3CDOM*. We have recently developed an alternative protocol based on 4-carboxybenzophenone (CBBP), the triplet state of which (3CBBP*) is less reactive compared to 3AQ2S*. Here we show that in the case of ibuprofen (IBP), paracetamol (APAP) and clofibric acid (CLO), the reaction rate constants with 3CBBP* are more reasonable as 3CDOM* reactivity estimates than those obtained by using AQ2S. In contrast, similar rate constants are measured for the reaction of atrazine (ATZ) with either 3AQ2S* or 3CBBP*. Moreover, the reactivity of ATZ with both 3AQ2S* and 3CBBP* is very similar to that with 3CDOM*, available through a literature estimate. The possibility to validate the ATZ-3CBBP* reactivity estimate against the 3CDOM* data, and to accurately predict the reported IBP and CLO field lifetime, support the suitability of CBBP as CDOM proxy. The replacement of AQ2S with CBBP as proxy molecule does not reverse the qualitative prediction, according to which 3CDOM* would be the main process involved in the photodegradation of the studied contaminants in waters with high dissolved organic carbon (DOC). However, the CBBP-based data prompt for an important reconsideration of the estimated lifetimes at high DOC

Confirmation of NIKA2 investigation of the Sunyaev-Zel’dovich effect by using synthetic clusters of galaxies

The NIKA2 Sunyaev-Zel’dovich Large Program (SZLP) is focused on mapping the thermal SZ signal of a representative sample of selected Planck and ACT clusters spanning the redshift range 0.5 < z < 0.9. Hydrodynamical N-body simulations prove to be a powerful tool to endorse NIKA2 capabilities for estimating the impact of IntraCluster Medium (ICM) disturbances when re- covering the pressure radial profiles. For this goal we employ a subsample of objects, carefully extracted from the catalog Marenostrum MUltidark SImulations of galaxy Clusters (MUSIC), spanning equivalent redshift and mass ranges as the LPSZ. The joint analysis of real observations of the tSZ with NIKA2 and Planck enables to validate the NIKA2 pipeline and to estimate the ICM pressure profiles. Moreover, the possibility to identify a priori the dynamical state of the selected synthetic clusters allows us to verify the impact on the recovered ICM profile shapes and their scatters. Morphological analysis of maps of the Compton parameter seems to be a way to observationally segregate the sample based on the dynamical state in relaxed and disturbed synthetic clusters

Confirmation of NIKA2 investigation of the Sunyaev-Zel’dovich effect by using synthetic clusters of galaxies

The NIKA2 Sunyaev-Zel’dovich Large Program (SZLP) is focused on mapping the thermal SZ signal of a representative sample of selected Planck and ACT clusters spanning the redshift range 0.5 < z < 0.9. Hydrodynamical N-body simulations prove to be a powerful tool to endorse NIKA2 capabilities for estimating the impact of IntraCluster Medium (ICM) disturbances when re- covering the pressure radial profiles. For this goal we employ a subsample of objects, carefully extracted from the catalog Marenostrum MUltidark SImulations of galaxy Clusters (MUSIC), spanning equivalent redshift and mass ranges as the LPSZ. The joint analysis of real observations of the tSZ with NIKA2 and Planck enables to validate the NIKA2 pipeline and to estimate the ICM pressure profiles. Moreover, the possibility to identify a priori the dynamical state of the selected synthetic clusters allows us to verify the impact on the recovered ICM profile shapes and their scatters. Morphological analysis of maps of the Compton parameter seems to be a way to observationally segregate the sample based on the dynamical state in relaxed and disturbed synthetic clusters

PRISM (Polarized Radiation Imaging and Spectroscopy Mission): an extended white paper

Contains fulltext : 126057.pdf (preprint version ) (Open Access

Transcatheter Aortic Valve Replacement with the Latest-Iteration Self-Expanding or Balloon-Expandable Valves: The Multicenter OPERA-TAVI Registry.

BACKGROUND The latest iterations of devices for transcatheter aortic valve replacement (TAVR) have brought refinements to further improve patient outcomes. OBJECTIVES This study sought to compare early outcomes of patients undergoing TAVR with the self-expanding (SE) Evolut PRO/PRO+ or balloon-expandable (BE) Sapien 3 ULTRA devices. METHODS The OPERA-TAVI registry collected data from 14 high-volume centers worldwide on patients undergoing TAVR with SE or BE devices. After excluding patients who were not eligible to both devices, patients were compared using 1:1 propensity score matching. The primary efficacy and safety outcomes were VARC-3 device success and early safety, respectively. RESULTS Among 2,241 patients eligible for the present analysis, 683 pairs of patients were matched. The primary efficacy outcome did not differ between patients receiving SE or BE transcatheter aortic valves (SE: 87.4% vs BE: 85.9%; P = 0.47), but BE device recipients showed a higher rate of the primary safety outcome (SE: 69.1% vs BE: 82.6%; P < 0.01). This finding was driven by the higher rates of permanent pacemaker implantation (PPI) (SE: 17.9% vs BE: 10.1%; P < 0.01) and disabling stroke (SE: 2.3% vs BE: 0.7%; P = 0.03) in SE device recipients. On post-TAVR echocardiography, the rate of moderate-to-severe paravalvular regurgitation was similar between groups (SE: 3.2% vs BE: 2.3%; P = 0.41), whereas lower mean transvalvular gradients were observed in the SE cohort (median SE: 7.0 vs BE: 12.0 mm Hg; P < 0.01). CONCLUSIONS The OPERA-TAVI registry showed that SE and BE devices had comparable VARC-3 device success rates, but the BE device had a higher rate of early safety. The higher PPI and disabling stroke rates in SE device recipients drove this composite endpoint

One-year clinical outcomes of transcatheter aortic valve implantation with the latest iteration of self-expanding or balloonexpandable devices: insights from the OPERA-TAVI registry.

BACKGROUND Midterm comparative analyses of the latest iterations of the most used Evolut and SAPIEN platforms for transcatheter aortic valve implantation (TAVI) are lacking. AIMS We aimed to compare 1-year clinical outcomes of TAVI patients receiving Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices in current real-world practice. METHODS Among patients enrolled in the OPERA-TAVI registry, patients with complete 1-year follow-up were considered for the purpose of this analysis. One-to-one propensity score matching was used to compare TAVI patients receiving PRO or ULTRA devices. The primary endpoint was a composite of 1-year all-cause death, disabling stroke and rehospitalisation for heart failure. Five prespecified subgroups of patients were considered according to leaflet and left ventricular outflow tract calcifications, annulus dimensions and angulation, and leaflet morphology. RESULTS Among a total of 1,897 patients, 587 matched pairs of patients with similar clinical and anatomical characteristics were compared. The primary composite endpoint did not differ between patients receiving PRO or ULTRA devices (Kaplan-Meier [KM] estimates 14.0% vs 11.9%; log-rank p=0.27). Patients receiving PRO devices had higher rates of 1-year disabling stroke (KM estimates 2.6% vs 0.4%; log-rank p=0.001), predominantly occurring within 30 days after TAVI (1.4% vs 0.0%; p=0.004). Outcomes were consistent across all the prespecified subsets of anatomical scenarios (all pinteraction>0.10). CONCLUSIONS One-year clinical outcomes of patients undergoing transfemoral TAVI and receiving PRO or ULTRA devices in the current clinical practice were similar, but PRO patients had higher rates of disabling stroke. Outcomes did not differ across the different anatomical subsets of the aortic root