Point-of-Use Mixing of Influenza H5N1 Vaccine and MF59 Adjuvant for Pandemic Vaccination Preparedness: Antibody Responses and Safety. A Phase 1 Clinical Trial.

BACKGROUND: Avian influenza A/H5N1 has threatened human health for nearly 2 decades. Avian influenza A vaccine without adjuvant is poorly immunogenic. A flexible rapid tactic for mass vaccination will be needed if a pandemic occurs. METHODS: A multicenter, randomized, blinded phase 1 clinical trial evaluated safety and antibody responses after point-of-use mixing of influenza A/Indonesia/05/2005 (H5N1) vaccine with MF59 adjuvant. Field-site pharmacies mixed 3.75, 7.5, or 15 mcg of antigen with or without MF59 adjuvant just prior to intramuscular administration on days 0 and 21 of healthy adults aged 18-49 years. RESULTS: Two hundred and seventy subjects were enrolled. After vaccination, titers of hemagglutination inhibition antibody ≥1:40 were achieved in 80% of subjects receiving 3.75 mcg + MF59 vs only 14% receiving 15 mcg without adjuvant (P < .0001). Peak hemagglutination inhibition antibody geometric mean titers for vaccine + MF59 were ∼65 regardless of antigen dose, and neutralizing titers were 2- to 3-fold higher. Vaccine + MF59 produced cross-reactive antibody responses against 4 heterologous H5N1 viruses. Excellent safety and tolerability were demonstrated. CONCLUSIONS: Point-of-use mixing of H5N1 antigen and MF59 adjuvant achieved target antibody titers in a high percentage of subjects and was safe. The feasibility of the point-of-use mixing should be studied further.

Favorable changes in serum estrogens and other biologic factors after weight loss in breast cancer survivors who are overweight or obese.

BACKGROUND: Obesity is associated with an increased risk for recurrence and all-cause mortality in breast cancer survivors. Excess adiposity is associated with increased estrogen, insulin, and leptin, and with decreased sex hormone binding globulin (SHBG) concentrations, which may promote breast cancer progression and recurrence. This study aimed to assess the effects of weight loss on these factors. PATIENTS AND METHODS: Breast cancer survivors who were overweight or obese (n = 220) and who were enrolled in a weight loss intervention study provided baseline and follow-up blood samples and weight data. Serum estrogens, SHBG, insulin, and leptin were measured at baseline, 6 months, and 18 months. RESULTS: Weight loss of ≥5% of initial weight decreased leptin and insulin compared with those who did not achieve that amount of weight loss (P < .0001). Weight loss also increased SHBG at 6 and 18 months (P < .01). Postmenopausal women who lost ≥5% of body weight at 6 months had lower estrone (P = .02), estradiol (P = .002), and bioavailable estradiol (P = .001) concentrations than women who did not lose at least 5% of body weight, and weight loss at 18 months was significantly related to a change in serum bioavailable estradiol concentration (P = .02). CONCLUSIONS: Favorable changes in estrogens, SHBG, insulin, and leptin were observed in association with weight loss in these women who were overweight or obese and who had been diagnosed and treated for breast cancer. Weight loss appears to have favorable effects on hormonal and biologic factors associated with increased risk for recurrence and poorer prognosis.

Bilateral endoscopic inguinofemoral lymphadenectomy using simultaneous carbon dioxide insufflation: an initial report of a novel approach.

Inguinal lymphadenectomy plays a critical role in the diagnosis and treatment of several neoplastic diseases. Frequently, bilateral lymphadenectomy is undertaken for staging and/or treatment of genitourinary cancers. Our objective was to determine if bilateral endoscopic lymphadenectomy could be performed simultaneously, in an effort to decrease overall anesthetic and operative time. This was accomplished by utilizing two carbon dioxide insufflators concurrently. This approach requires careful positioning of the patient, surgical team, and instrumentation, as well as special anesthetic considerations necessary to avoid severe hypercarbia. Simultaneous bilateral endoscopic inguinal lymphadenectomy is a technically feasible and efficient surgical approach.

Activation of bestrophin Cl- channels is regulated by C-terminal domains.

Bestrophins (VMD2, VMD2L1, VMD2L2, and VMD2L3) are a new family of anion channels. The mechanisms of their regulation are not yet well understood. Recently, we found that a domain (amino acids 356-364) in the C terminus of mouse VMD2L3 (mBest3) inhibited channel activity when it was expressed in HEK293 cells (Qu, Z., Cui, Y., and Hartzell, H. C. (2006) FEBS Lett. 580, 2141-2214). Here we show that this auto-inhibitory (AI) domain in mBest3 and human (h)Best3 is composed of seven critical residues, (356)IPSFLGS(362). Replacement of any residue (except Pro(357)) in the domain with alanine activated Cl(-) currents. Substitution of Pro(357) with other amino acids, especially phenylalanine, did activate currents. Membrane biotinylation demonstrated that nonfunctional mBest3 protein was trafficked to the plasma membrane, implying that the AI domain inhibited channel gating but not trafficking. mBest3-F359A and hBest3-G361A mutations induced outwardly rectifying currents, suggesting that the AI domain is associated with the channel pore or gating mechanism. Supporting this suggestion, the mBest3 AI domain was demonstrated to be located within a membrane-associated region. When the wild-type mBest3 C terminus (amino acids 292-669) was expressed in HEK293 cells, the protein was located mainly in the particulate fraction, but it became soluble when a sequence containing the AI domain was deleted (Delta353-404). There is an AI domain ((357)QPSFQGS(363)) in mouse VMD2L1 (mBest2) as well, but its inhibitory effect is competed by a downstream facilitatory sequence (amino acids 405-454). These results suggest that an auto-inhibitory mechanism in C termini may be universal among bestrophins investigated in the study.