Genetic Vaccination-Induced Immune Responses to the Human Immunodeficiency Virus Protein Rev: Emergence of the Interleukin 2-Producing Helper T Lymphocyte

Overview summary The immune system poses a major obstacle to the long-term success of in vivo gene therapies. Immune responses to foreign transgene products and/or the vectors that facilitate gene transfer may neutralize the transgene product, eliminate transfected cells, and culminate in inflammation within transfected tissues. The majority of studies that address these issues have focused on cytotoxic T lymphocyte (CTL) and antibody responses induced by gene transfer. However, the IL-2-producing helper T lymphocyte (HTL) represents a critical regulatory cell that likely influences the inductive phase of the immune response following gene transfer. The current study employed limiting dilution analysis (LDA) techniques to characterize the development of IL-2-producing HTLs induced by genetic vaccination with a plasmid encoding the mutated HIV protein Rev M10. Further, we assessed the ability to inhibit the transgene-induced HTL response by cotransfer of a plasmid encoding the immunosuppressive cytokine TGFβ1.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63282/1/hum.1998.9.15-2187.pd

Apixaban versus warfarin in patients with atrial fibrillation

BACKGROUND: Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin. METHODS: In this randomized, double-blind trial, we compared apixaban (at a dose of 5 mg twice daily) with warfarin (target international normalized ratio, 2.0 to 3.0) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke. The primary outcome was ischemic or hemorrhagic stroke or systemic embolism. The trial was designed to test for noninferiority, with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause. RESULTS: The median duration of follow-up was 1.8 years. The rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group (hazard ratio with apixaban, 0.79; 95% confidence interval [CI], 0.66 to 0.95; P<0.001 for noninferiority; P = 0.01 for superiority). The rate of major bleeding was 2.13% per year in the apixaban group, as compared with 3.09% per year in the warfarin group (hazard ratio, 0.69; 95% CI, 0.60 to 0.80; P<0.001), and the rates of death from any cause were 3.52% and 3.94%, respectively (hazard ratio, 0.89; 95% CI, 0.80 to 0.99; P = 0.047). The rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group (hazard ratio, 0.51; 95% CI, 0.35 to 0.75; P<0.001), and the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group and 1.05% per year in the warfarin group (hazard ratio, 0.92; 95% CI, 0.74 to 1.13; P = 0.42). CONCLUSIONS: In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality. Copyright © 2011 Massachusetts Medical Society. All rights reserved