Periodontal Diagnosis and Treatment Planning Among Indiana Dental Faculty, Periodontists, and General Practice Dentists: A Multi-Group Comparison.

Diagnosis and treatment planning for periodontal disease are fraught with challenges because of the complex and multifactorial nature of the disease as well as the inherent variability in interpretation of clinical findings. It is important for all practitioners to be accurate and consistent in formulating diagnoses based on the American Academy of Periodontology classification guidelines and to implement treatment plans to adequately address patients' needs. The aim of this study was to compare diagnoses and treatment plans among four groups of participants: full-time and part-time periodontology faculty at Indiana University School of Dentistry (IUSD), full-time and part-time IUSD general practice faculty, full-time periodontists in private practice, and full-time general practitioners in private practice. The study, conducted September 2016 to February 2017, also sought to determine if the calibrated participants had more correct diagnoses and treatment plans than those who had not received calibration training. Each of the four groups had 20 participants each. Participants evaluated ten de-identified case records and selected a diagnosis and treatment plan for each case. In the results, the 20 IUSD periodontal faculty members, most of whom had participated in calibration sessions, had overall better agreement and more correct responses for diagnoses and treatment plans than the IUSD general practice faculty members, private practice general practitioners, and private practice periodontists (only one of those 60 participants had participated in calibration sessions). The results supported the notion that periodic calibration is needed to standardize faculty criteria, facilitate better agreement and accuracy, and enhance consistency in the use of clinical criteria during training for dental students and in practice.

Peri-Implant Bone Loss and Peri-Implantitis: A Report of Three Cases and Review of the Literature.

Dental implant supported restorations have been added substantially to the clinical treatment options presented to patients. However, complications with these treatment options also arise due to improper patient selection and inadequate treatment planning combined with poor follow-up care. The complications related to the presence of inflammation include perimucositis, peri-implant bone loss, and peri-implantitis. Prevalence rates of these complications have been reported to be as high as 56%. Treatment options that have been reported include nonsurgical therapy, the use of locally delivered and systemically delivered antibiotics, and surgical protocols aimed at regenerating the lost bone and soft tissue around the implants. The aim of this article is to report on three cases and review some of the treatment options used in their management.

Spirocyclic ß-site amyloid precursor protein cleaving enzyme 1 (BACE1) inhibitors: from hit to lowering of cerebrospinal fluid (CSF) amyloid ß in a higher species.

A hallmark of Alzheimer's disease is the brain deposition of amyloid beta (Aß), a peptide of 36-43 amino acids that is likely a primary driver of neurodegeneration. Aß is produced by the sequential cleavage of APP by BACE1 and γ-secretase; therefore, inhibition of BACE1 represents an attractive therapeutic target to slow or prevent Alzheimer's disease. Herein we describe BACE1 inhibitors with limited molecular flexibility and molecular weight that decrease CSF Aß in vivo, despite efflux. Starting with spirocycle 1a, we explore structure-activity relationships of core changes, P3 moieties, and Asp binding functional groups in order to optimize BACE1 affinity, cathepsin D selectivity, and blood-brain barrier (BBB) penetration. Using wild type guinea pig and rat, we demonstrate a PK/PD relationship between free drug concentrations in the brain and CSF Aß lowering. Optimization of brain exposure led to the discovery of (R)-50 which reduced CSF Aß in rodents and in monkey.

Phase I pharmacokinetic and pharmacodynamic study of the oral, small-molecule mitogen-activated protein kinase kinase 1/2 inhibitor AZD6244 (ARRY-142886) in patients with advanced cancers.

PURPOSE: To assess the tolerability, pharmacokinetics (PKs), and pharmacodynamics (PDs) of the mitogen-activated protein kinase kinase (MEK) 1/2 inhibitor AZD6244 (ARRY-142886) in patients with advanced cancer. PATIENTS AND METHODS: In part A, patients received escalating doses to determine the maximum-tolerated dose (MTD). In both parts, blood samples were collected to assess PK and PD parameters. In part B, patients were stratified by cancer type (melanoma v other) and randomly assigned to receive the MTD or 50% MTD. Biopsies were collected to determine inhibition of ERK phosphorylation, Ki-67 expression, and BRAF, KRAS, and NRAS mutations. RESULTS: Fifty-seven patients were enrolled. MTD in part A was 200 mg bid, but this dose was discontinued in part B because of toxicity. The 50% MTD (100 mg bid) was well tolerated. Rash was the most frequent and dose-limiting toxicity. Most other adverse events were grade 1 or 2. The PKs were less than dose proportional, with a median half-life of approximately 8 hours and inhibition of ERK phosphorylation in peripheral-blood mononuclear cells at all dose levels. Paired tumor biopsies demonstrated reduced ERK phosphorylation (geometric mean, 79%). Five of 20 patients demonstrated >or= 50% inhibition of Ki-67 expression, and RAF or RAS mutations were detected in 10 of 26 assessable tumor samples. Nine patients had stable disease (SD) for >or= 5 months, including two patients with SD for 19 (thyroid cancer) and 22 (uveal melanoma plus renal cancer) 28-day cycles. CONCLUSION: AZD6244 was well tolerated with target inhibition demonstrated at the recommended phase II dose. PK analyses supported twice-daily dosing. Prolonged SD was seen in a variety of advanced cancers. Phase II studies are ongoing.

Biological characterization of ARRY-142886 (AZD6244), a potent, highly selective mitogen-activated protein kinase kinase 1/2 inhibitor.

PURPOSE: The Ras-Raf-mitogen-activated protein kinase kinase (MEK) pathway is overactive in many human cancers and is thus a target for novel therapeutics. We have developed a highly potent and selective inhibitor of MEK1/2. The purpose of these studies has been to show the biological efficacy of ARRY-142886 (AZD6244) in enzymatic, cellular, and animal models. EXPERIMENTAL DESIGN: The ability of ARRY-142886 to inhibit purified MEK1 as well as other kinases was evaluated. Its effects on extracellular signal-regulated kinase (ERK) phosphorylation and proliferation in several cell lines were also determined. Finally, the inhibitor was tested in HT-29 (colorectal) and BxPC3 (pancreatic) xenograft tumor models. RESULTS: The IC(50) of ARRY-142886 was determined to be 14 nmol/L against purified MEK1. This activity is not competitive with ATP, which is consistent with the high specificity of compound for MEK1/2. Basal and epidermal growth factor-induced ERK1/2 phosphorylation was inhibited in several cell lines as well as 12-O-tetradecanoylphorbol-13-acetate-induced ERK1/2 phosphorylation in isolated peripheral blood mononuclear cells. Treatment with ARRY-142886 resulted in the growth inhibition of several cell lines containing B-Raf and Ras mutations but had no effect on a normal fibroblast cell line. When dosed orally, ARRY-142886 was capable of inhibiting both ERK1/2 phosphorylation and growth of HT-29 xenograft tumors in nude mice. Tumor regressions were also seen in a BxPC3 xenograft model. In addition, tumors remained responsive to growth inhibition after a 7-day dosing holiday. CONCLUSIONS: ARRY-142886 is a potent and selective MEK1/2 inhibitor that is highly active in both in vitro and in vivo tumor models. This compound is currently being investigated in clinical studies.

Cation-Templated Self-Assembly of a Lipophilic Deoxyguanosine: Solution Structure of a K+-dG8 Octamer.

The lipophilic nucleoside 3',5'-didecanoyl-2'-deoxyguanosine, dG 1, extracts potassium salts from water into organic solvents. The K+ extraction drives the self-association of dG 1 to give G-quartet structures. A series of 1H NMR experiments indicates that the identity of the assembled species in CDCl3 is modulated by the amount of K+ extracted by dG 1. At an 8:1 dG 1 to K+ picrate ratio, the octamer (dG 1)8-K+ predominates in solution. The (dG 1)8-K+ supramolecular complex, formed by coordination of a single K+ ion by eight dG 1 monomers, is robust and structurally unique. The 1H NMR chemical shifts for both the exchangeable and nonexchangeable protons of (dG 1)8-KI in CDCl3 were assigned from a combination of 2D 1H-1H and 13C-1H correlation experiments. One set of 1H NMR signals corresponds to a dG 1 nucleoside with an anti conformation about the C(1')-N(9) glycosidic bond, whereas the other set of signals is due to 50% of the didecanoyl dG 1 adopting a syn conformation. Although the possible arrangements of an octamer containing a 1:1 ratio of anti dG 1 to syn dG 1 are many, the present NMR analysis leads to a defined single species composed of two G-quartets. In one tetramer, all of the dG 1 components have a syn conformation about the C(1')-N(9) glycosidic bond, while the other tetramer has an "all-anti" conformation. Moreover, intertetramer NOEs are consistent with stacking of the "all-anti" tetramer in a "head-to-tail" orientation on top of the "all-syn" tetramer, thus sandwiching a central K+ ion. This solution structure is, to our knowledge, different from all of the assembled structures described so far for guanine aggregates. Presumably, the K+-bound octamer represents the first observable stage of the assembly process in the aggregation of dG 1.