Patient data meta-analysis of Post-Authorization Safety Surveillance (PASS) studies of haemophilia A patients treated with rAHF-PFM.

UNLABELLED: A Post-Authorization Safety Study (PASS) global program was designed to assess safety and effectiveness of rAHF-PFM (ADVATE) use in haemophilia patients in routine clinical settings. The main aim of this project was to estimate the rate of inhibitors and other adverse events across ADVATE-PASS studies by meta-analysing individual patient data (IPD). Eligible Studies: PASS studies conducted in different countries, between 2003 and 2013, for which IPD were provided. Eligible patients: haemophilia A patients with baseline FVIII:C < 5%, with a known number of prior exposure days (EDs). PRIMARY OUTCOME: de novo inhibitors in severe, previously treated patients (PTPs) with > 150 EDs. SECONDARY OUTCOMES: de novo inhibitors according to prior exposure and disease severity; other adverse events; annualized bleeding rate (ABR). ANALYSIS: random-effects logistic regression. Five of seven registered ADVATE-PASS (Australia, Europe, Japan, Italy and USA) and 1188 patients were included (median follow-up 384 days). Among severe PTPs with > 150 EDs, 1/669 developed de novo inhibitors (1.5 per 1000; 95% confidence interval [CI] 0.2, 10.6 per 1000). Among all patients included in the PASS studies, 21 developed any type of inhibitors (2.0%, 95% CI: 0.8%, 4.7%). Less than 1% of patients presented with other serious adverse events possibly related to ADVATE. The overall median ABR was 3.83 bleeds/year (first, third quartiles: 0.60, 12.90); 1.66 (0, 4.78) in the 557 patients continuously on prophylaxis ≥ twice/week. Meta-analysing PASS data from different countries confirmed the overall favourable safety and effectiveness profile of ADVATE in routine clinical settings.

Epidermal growth factor receptor - but not histamine receptor - is upregulated in seasonal allergic rhinitis.

BACKGROUND: We were interested in exploring the molecular mechanisms underlying the observed difference in histamine (H) responsiveness between seasonal allergic rhinitic (SAR) and nonrhinitic (NR) subjects. We hypothesized that SAR subjects express higher nasal mucosal histamine receptor 1 (H1R) and 2 (H2R) levels than do NR subjects. In addition, we examined expression of genes involved in regulating the glandular response, including epidermal growth factor (EGF), EGF receptor (EGFR), and mucins (Muc5Ac and Muc5B). METHODS: Fourteen subjects, seven SAR and seven NR, were provoked during pollen season with doubling doses of H (0.125-8.0 mg/ml). Nasal airway resistance (NAR) was measured by active posterior rhinomanometry. Provocation was halted when NAR exceeded 150% of baseline. Prior to provocation, nasal scrapings were obtained and mRNA quantified using two-step real-time PCR. RESULTS: The mean PD50 (concentration of H producing a 50% increase in NAR) was significantly lower in the SAR than NR group (0.36 vs 1.32 mg/ml; P < 0.05). The ratio of relative gene copy numbers between the SAR and NR groups were as follows: H1R, 0.85 (P = 0.52); H2R, 0.67 (P = 0.35); EGF, 1.02 (P = 0.93), and EGFR, 103.5 (P < 0.05). CONCLUSIONS: There were no significant differences in H1R or H2R mRNA levels between SAR and NR subjects in-season, despite observed differences in H reactivity. SAR subjects, however, did show a significant elevation in EGFR expression, consistent with the observation of mucus hypersecretion in allergic rhinitis.

Chlorine inhalation produces nasal congestion in allergic rhinitics without mast cell degranulation.

Seasonal allergic rhinitic (SAR) subjects are more sensitive to nasal irritants than nonrhinitic (NR) subjects; however, the mechanism underlying this difference is unclear. This study sought to determine whether irritant-induced nasal congestion involves mast cell degranulation. Eight SAR and eight NR subjects were exposed to both 1.0 parts per million chlorine and filtered air in separate visits; exposures were via nasal mask and lasted 15 min. Rhinomanometry was performed before, immediately after and 15 min after exposure. Following > or = 2 weeks, exposures and symptom reporting were repeated with nasal lavage, rather than rhinomanometry, pre- and postexposure. A separate substudy using rye grass antigen provided a positive control. Mast cell tryptase was measured in nasal lavage fluid from both substudies using an automated fluoroenzyme immunoassay. Chlorine provocation significantly increased nasal airway resistance in SAR but not NR subjects. Conversely, tryptase levels in nasal lavage fluid were unaffected. Nasal allergen challenge significantly increased both nasal obstruction and nasal lavage tryptase in SAR subjects. Irritant-induced nasal congestion is more pronounced among seasonal allergic rhinitic than nonrhinitic subjects. However, unlike nasal allergen challenge, the mechanism of response to chlorine does not appear to involve mast cell degranulation.

Lung mucin production is stimulated by the air pollutant residual oil fly ash.

Human and animal exposure to particulate air pollution is correlated with airway mucus hypersecretion and increased susceptibility to infection. Seeking clues to the mechanisms underlying this pathology, we examined the effect of the particulate air pollutant residual oil fly ash (ROFA) on production of the major component of mucus, mucin, and the major antibacterial protein of the respiratory tract, lysozyme. We found that following in vitro exposure to ROFA, epithelial cells showed an increase in mucin (MUC5AC) and lysozyme (LYS) steady state mRNA. This upregulation was controlled at least partly at the level of transcription as shown by reporter assays. Experiments testing the ability of the major components of ROFA to mimic these effects showed that vanadium, a metal making up 18.8% by weight, accounted for the bulk of the response. A screen of signaling inhibitors showed that MUC5AC and LYS induction by ROFA are mediated by dissimilar signaling pathways, both of which are, however, phosphotyrosine dependent. Recognizing that the ROFA constituent vanadium is a potent tyrosine phosphatase inhibitor and that mucin induction by pathogens is phophotyrosine dependent, we suggest that vanadium-containing air pollutants trigger disease-like conditions by unmasking phosphorylation-dependent pathogen resistance pathways.

Effect of fibroblast growth factors on outgrowth of facial mesenchyme.

The ectoderm is required for outgrowth of facial prominences and facial ectoderm from all facial prominences is interchangeable. Signals provided by the ectoderm may include members of the fibroblast growth factor family (FGF). In order to test whether FGFs could replace facial ectoderm and promote outgrowth, stage 24 frontonasal mass or mandibular mesenchyme was grafted to a host chick limb and a bead soaked in FGF-2 or FGF-4 was placed on top of the mesenchyme. Following 7 days of incubation, the amount of outgrowth was quantified by measuring the rods of cartilage that formed from the grafts. FGF-2 and FGF-4 stimulated an increase in length of cartilage rods in mandibular grafts compared to mandibular mesenchyme grafted without ectoderm (P < 0.05). FGF-4 stimulated a small increase in length of frontonasal mass mesenchyme (P < 0.05) and both FGFs increased the frequency of egg tooth formation in frontonasal mass mesenchyme compared to frontonasal mass mesenchyme grafted without ectoderm. FGFs can partially but not completely replace facial ectoderm since homotypic recombinations of frontonasal mass and mandibular tissues were significantly longer than mesenchyme grafts treated with FGF-soaked beads (P < 0.05). The addition of a second FGF-soaked bead did not significantly increase the length of the frontonasal mass or the mandibular mesenchyme. We have determined that FGF-2 protein is expressed in facial ectoderm and could be an endogenous signal for outgrowth. In contrast, FGF-8 transcripts are not expressed in the ectoderm covering the areas of the face that were grafted; thus, it is less likely that FGF-8 is required for outgrowth. Our results indicate that FGFs are part of an endogenous signaling pathway involved in distal outgrowth and chondrogenesis of the facial prominences.

Epithelium is required for maintaining FGFR-2 expression levels in facial mesenchyme of the developing chick embryo.

In the developing chick embryo, fibroblast growth factor-2 (FGFR-2) expression patterns correlate with outgrowth of facial prominences. Frontonasal mass prominences that form the pre-nasal cartilage and upper beak express high levels of FGFR-2 receptor, whereas maxillary prominences that form the flattened corners of the beak and palatal shelves express low FGFR-2 transcript levels. Facial epithelium is an abundant source of FGFs and is required to support outgrowth of mesenchymal tissue, including cartilage rod formation. Because FGFR-2 is highly expressed in regions of facial outgrowth and because epithelium is required for outgrowth of facial prominences, epithelium could be required to maintain FGFR-2 transcripts in facial mesenchyme. To test this hypothesis, we removed epithelium to inhibit outgrowth of regions of the embryonic face, grafted frontonasal mass and maxillary prominences into a host limb bud, and then examined changes in FGFR-2 expression using in situ hybridization. We also hybridized adjacent sections with collagen II probe to identify regions undergoing chondrogenesis. Our results indicate that removal of epithelium from frontonasal mass led to a decrease in FGFR-2 and collagen II expression 24 hr after grafting to host and that neither FGFR-2 nor collagen II expression increased to expected levels at 48 hr. These results suggest that there are signals in the epithelium required for increasing FGFR-2 and collagen II gene transcription, and the expression of these genes are linked to outgrowth of facial prominences.