Randomised, multicentre, phase III, open-label study of alectinib vs crizotinib in treatment-naïve anaplastic lymphoma kinase (ALK)-positive advanced NSCLC (ALEX study).

Background: In ∼5% of advanced NSCLC tumours, ALK tyrosine kinase is constitutively activated after translocation of ALK. ALK+ NSCLC was shown to be highly sensitive to the first approved ALK inhibitor, crizotinib. However, all pts eventually relapse on crizotinib mainly due to secondary ALK mutations/amplification or CNS metastases. Alectinib is a highly selective, potent, oral next-generation ALK inhibitor. Clinical phase II alectinib data in 46 crizotinib-naïve pts with ALK+ NSCLC reported an objective response rate (ORR) of 93.5% and a 1-year progression-free rate of 83% (95% CI: 68-92) (Inoue et al. J Thorac Oncol 2013). CNS activity was seen: of 14 pts with baseline brain metastasis, 11 had prior CNS radiation, 9 of these experienced CNS and systemic PFS of >12 months; of the 3 pts without prior CNS radiation, 2 were >15 months progression free. Trial design: Randomised, multicentre, phase III, open-label study in pts with treatment-naïve ALK+ advanced, recurrent, or metastatic NSCLC. All pts must provide pretreatment tumour tissue to confirm ALK rearrangement (by IHC). Pts (∼286 from ∼180 centres, ∼30 countries worldwide) will be randomised to alectinib (600mg oral bid, with food) or crizotinib (250mg oral bid, with/without food) until disease progression (PD), unacceptable toxicity, withdrawal of consent, or death. Stratification factors are: ECOG PS (0/1 vs 2), race (Asian vs non-Asian), baseline CNS metastases (yes vs no). Primary endpoint: PFS by investigators (RECIST v1.1). Secondary endpoints: PFS by Independent Review Committee (IRC); ORR; duration of response; OS; safety; pharmacokinetics; quality of life. Additionally, time to CNS progression will be evaluated (MRI) for the first time in a prospective randomised NSCLC trial as a secondary endpoint. Pts with isolated asymptomatic CNS progression will be allowed to continue treatment beyond documented progression until systemic PD and/or symptomatic CNS progression, according to investigator opinion. Time to CNS progression will be retrospectively assessed by the IRC using two separate criteria, RECIST and RANO. Further details: ClinicalTrials.gov (NCT02075840). Disclosure: T.S.K. Mok: Advisory boards: AZ, Roche, Eli Lilly, Merck Serono, Eisai, BMS, AVEO, Pfizer, Taiho, Boehringer Ingelheim, Novartis, GSK Biologicals, Clovis Oncology, Amgen, Janssen, BioMarin; board of directors: IASLC; corporate sponsored research: AZ; M. Perol: Advisory boards: Roche; S.I. Ou: Consulting: Pfizer, Chugai, Genentech Speaker Bureau: Pfizer, Genentech, Boehringer Ingelheim; I. Bara: Employee: F. Hoffmann-La Roche Ltd; V. Henschel: Employee and stock: F. Hoffmann-La Roche Ltd.; D.R. Camidge: Honoraria: Roche/Genentech. All other authors have declared no conflicts of interest.

Design and production of protein nanostructures for biomolecular detection

Particulate nanostructures are increasingly used for analytical purposes. Such particles are often generated by chemical synthesis from non-renewable raw materials. Generation of uniform nanoscale particles is challenging and particle surfaces must be modified to make the particles biocompatible and water-soluble. Usually nanoparticles are functionalized with binding molecules (e.g., antibodies or their fragments) and a label substance (if needed). Overall, producing nanoparticles for use in bioaffinity assays is a multistep process requiring several manufacturing and purification steps. This study describes a biological method of generating functionalized protein-based nanoparticles with specific binding activity on the particle surface and label activity inside the particles. Traditional chemical bioconjugation of the particle and specific binding molecules is replaced with genetic fusion of the binding molecule gene and particle backbone gene. The entity of the particle shell and binding moieties are synthesized from generic raw materials by bacteria, and fermentation is combined with a simple purification method based on inclusion bodies. The label activity is introduced during the purification. The process results in particles that are ready-to-use as reagents in bioaffinity. Apoferritin was used as particle body and the system was demonstrated using three different binding moieties: a small protein, a peptide and a single chain Fv antibody fragment that represents a complex protein including disulfide bridge.If needed, Eu3+ was used as label substance. The results showed that production system resulted in pure protein preparations, and the particles were of homogeneous size when visualized with transmission electron microscopy. Passively introduced label was stably associated with the particles, and binding molecules genetically fused to the particle specifically bound target molecules. Functionality of the particles in bioaffinity assays were successfully demonstrated with two types of assays; as labels and in particle-enhanced agglutination assay. This biological production procedure features many advantages that make the process especially suited for applications that have frequent and recurring requirements for homogeneous functional particles. The production process of ready, functional and watersoluble particles follows principles of “green chemistry”, is upscalable, fast and cost-effective.

Patson Approach versus the Standard Approach for increasing breast reconstruction rates in women undergoing mastectomy. A randomized, controlled, open-label clinical trial

Breast cancer is the most prevalent neoplasm among women in the majority of countries worldwide. Breast cancer treatment include mastectomy which is associated to strong impact in women. Breast reconstruction is an option for many women to re-establish their body image and also to decrease psychological impact. However, breast reconstruction rates are low and many factors are involved in not undergoing breast reconstruction. Patient involvement in the decision-making process increases breast reconstruction rates and is associated to higher satisfaction and less anxiety and depression symptoms. More physician-patient relation and more education in terms of breast reconstruction are needed to achieve our objective. A new approach of medical care, called Patson Approach, is created in order to meet our goal with more patient involvement, as well as, physician and psychological counsellingObjective: to increase breast reconstruction rates in women who are candidates for breast reconstruction after mastectomy and are included in the Patson Approach compared to women included in the Standard ApproachMethods: the study design will be a randomized, controlled, open-label clinical trial. 62 patients will be recruited during two years and randomly divided in two groups, 31 will be included in the Standard Approach and 31 will be included in the Patson Approach. Preoperative and postoperative appointments are established in order to do a follow-up of the patients and collect all the data

DNA alters the bilayer structure of cationic lipid diC14-amidine: A spin label study

Cationic lipids-DNA complexes (lipoplexes) have been used for delivery of nucleic acids into cells in vitro and in vivo. Despite the fact that, over the last decade, significant progress in the understanding of the cellular pathways and mechanisms involved in lipoplexes-mediated gene transfection have been achieved, a convincing relationship between the structure of lipoplexes and their in vivo and in vitro transfection activity is still missing. How does DNA affect the lipid packing and what are the consequences for transfection efficiency is the point we want to address here. We investigated the bilayer organization in cationic liposomes by electron spin resonance (ESR). Phospholipids spin labeled at the 5th and 16th carbon atoms were incorporated into the DNA/diC14-amidine complex. Our data demonstrate that electrostatic interactions involved in the formation of DNA-cationic lipid complex modify the packing of the cationic lipid membrane. DNA rigidifies the amidine fluid bilayer and fluidizes the amidine rigid bilayer just below the gel-fluid transition temperature. These effects were not observed with single nucleotides and are clearly related to the repetitive charged motif present in the DNA chain and not to a charge-charge interaction. These modifications of the initial lipid packing of the cationic lipid may reorient its cellular pathway towards different routes. A better knowledge of the cationic lipid packing before and after interaction with DNA may therefore contribute to the design of lipoplexes capable to reach specific cellular targets. (c) 2009 Elsevier B.V. All rights reserved.

Níveis nutricionais de cálcio para aves de corte ISA Label criadas sob semiconfinamento

Determinaram-se os níveis nutricionais de cálcio (Ca) para aves, machos e fêmeas, da linhagem ISA Label, nas fases inicial (um a 28 dias), crescimento (28 a 56 dias) e final (56 a 84 dias). Foram realizados três ensaios, um para cada fase, e, em cada ensaio, 480 aves com idade correspondente à fase de criação foram alojadas em 24 unidades experimentais com áreas de abrigo e de pastejo. Foi utilizado delineamento inteiramente ao acaso, em esquema fatorial 4x2 (Ca e sexo), totalizando oito tratamentos com três repetiç ões de 20 aves. Avaliaram-se: ganho de peso (GP); consumo de dieta (CD); conversão alimentar (CA); teores de fósforo (PT), de cálcio (CaT) e de cinzas na tíbia (CT) e resistência à quebra óssea (RQO). Na fase inicial, recomenda-se 1,16% de Ca na dieta, para aves de ambos os sexos, na fase de crescimento, 0,78 e 0,88% de Ca para machos e fêmeas, respectivamente, e, na fase final, 0,69% de Ca na dieta para ambos os sexos.

Exigências de metionina + cistina digestível para aves de corte ISA Label criadas em semiconfinamento

Foram realizados três experimentos para determinação das exigências de metionina+cistina (met+cis) digestível para aves da linhagem ISA Label. As aves foram criadas em semiconfinamento nas fases inicial (1 a 28 dias), crescimento (28 a 56 dias) e final (56 a 84 dias). em cada experimento, foram utilizadas 480 aves (metade de cada sexo) alojadas em 24 piquetes. O delineamento experimental utilizado foi o inteiramente casualizado, em esquema fatorial 4 × 2 (níveis de met+cis e sexos) com três repetições de 20 aves. Os níveis de met+cis digestível avaliados foram: 0,532; 0,652; 0,772; 0,892% na fase inicial; 0,515; 0,635; 0,755; 0,875% na fase de crescimento; e 0,469; 0,589; 0,709; 0,829% na fase final. Foram avaliados o desempenho, as características de carcaça, a deposição de proteína e gordura corporal, o peso e o teor de proteína das penas. Na fase inicial, os níveis de met+cis digestível na ração recomendados para machos e fêmeas foram 0,76 e 0,80%, que correspondem a 0,252 e 0,268% de met+cis por Mcal de energia metabolizável da ração, respectivamente. Para aves ISA Label na fase de crescimento, recomenda-se 0,716% de met+cis digestível na ração, independentemente do sexo, que corresponde a 0,235% de met+cis por Mcal de em da ração. Na fase final, recomendam-se níveis de met+cis digestível de 0,756 e 0,597%, que correspondem a 0,244 e 0,193% de met+cis por Mcal de energia metabolizável na ração para machos e fêmeas, respectivamente.

Exigências de lisina digestível para aves de corte da linhagem ISA Label criadas em semiconfinamento

Foram realizados três experimentos para determinar as exigências de lisina digestível para aves da linhagem ISA Label, de ambos os sexos, criadas em semiconfinamento durante as fases: inicial (1 a 28 dias), de crescimento (28 a 56 dias) e final (56 a 84 dias). em cada experimento, foram utilizadas 480 aves, alojadas em 24 piquetes, cada um contendo abrigo coberto de 3,13m² e área de pastejo de 72,87m². O delineamento experimental utilizado foi o inteiramente ao acaso, em esquema fatorial 4x2 (níveis de lisina e sexo) com três repetições de 20 aves cada. Os níveis de lisina digestível avaliados foram: 0,850; 0,970; 1,090 e 1,210% na fase inicial; 0,750; 0,870; 0,990 e 1,110% na fase de crescimento e 0,640; 0,760; 0,880 e 1,000% na fase final. Foram mensuradas as variáveis de desempenho, característica de carcaça, deposição de proteína e gordura corporal, peso e teor de proteína das penas. Com base nos resultados de desempenho, recomendam-se 1, 041; 1,006 e 0,760% de lisina digestível em rações para aves ISA Label nas fases inicial, de crescimento e final, respectivamente.

Digestible methionine plus cystine requirements of ISA Label broilers reared in free-range system

Three assays were carried out to determine the digestible methionine+cystine (Met+Cys) requirement for ISA Label broilers from both sexes. The birds were reared in free range system on starting phase (1 to 28 days), growing phase (28 to 56 days) and finishing phase (56 to 84 days). Four hundred and eighty birds were distributed into 24 pens, each one composed of shelter (3.13 m(2)) and pasture (72.87 m(2)). The experimental design was completely randomized with eight treatments as factorial arrangement (four Met+Cys levels and two sexes) with three replicates of 20 birds. The digestible Met+Cys levels were 0.532; 0.652; 0.772; 0.892% for starting phase; 0.515; 0.635; 0.755; 0.875% for growing phase and 0.469; 0.589; 0.709; 0.829% for finishing phase. The analyzed parameters were performance, carcass yield, body protein and fat deposition, weight and protein concentration in feathers. In the starting phase, the digestible Met+Cys level estimated for males was 0.765 and 0.803% for females, corresponding to 0.252 and 0.268% of Met+Cys/Mcal of ME, respectively. For the growing phase, the digestible Met+Cys level estimated was 0.716% for both sexes, corresponding to 0.235% of Met+Cys/Mcal of ME. For the finishing phase, the Met+Cys levels were 0.756 and 0.597% for males and females, corresponding to 0.244 and 0.193% of Met+Cys/Mcal of ME respectively.

Modelos matemáticos para estimar as exigências de lisina digestível para aves de corte ISA Label

O objetivo neste estudo foi avaliar diferentes modelos ajustados às respostas de ganho de peso obtidas em experimento com aves da linhagem ISA Label no período de 1 a 28 dias de idade. Foram utilizados 480 pintos de ambos os sexos, distribuídos em delineamento inteiramente casualizado, em arranjo fatorial 4 X 2 (níveis de lisina X sexo), com três repetições, com 20 aves por unidade experimental. Uma ração basal foi formulada para atender às exigências das aves, exceto em lisina. Essa ração foi suplementada com L-lisina HCl em substituição ao ácido L-glutâmico, resultando em rações experimentais isonitrogênicas e isoenergéticas contendo 0,85; 0,97; 1,09 e 1,21% de lisina digestível. As respostas de ganho de peso foram ajustadas de acordo com os níveis de lisina da ração pelos modelos Linear Reponse Plateau (LRP), segmentado de duas inclinações, polinomial quadrático e exponencial. A primeira intersecção da equação quadrática com o platô do LRP também foi utilizado para estimar o nível ótimo. Os níveis de lisina digestível estimados pelos modelos LRP, segmentado e quadrático, foram 0,999; 1,010 e 1,116%, respectivamente. Na combinação do modelo quadrático com o LRP, a estimativa da exigência de lisina digestível foi de 1,041%. O modelo exponencial proporcionou estimativa de 1,066%, considerando 95% da resposta assintótica. Com base nos custos com alimentação, esse mesmo modelo gerou estimativas de 1,000 e 1,030% quando o custo do quilograma de L-lisina HCl foi R$ 8,50 e R$ 6,50, respectivamente. Considerando as limitações de cada um dos modelos propostos, o procedimento para estimar as exigências de lisina digestível pela primeira intersecção da equação quadrática com o platô do LRP foi o mais adequado para melhorar o ganho de peso das aves quando variáveis econômicas não foram consideradas.

Níveis nutricionais de fósforo disponível para aves de corte ISA Label criadas em semiconfinamento

Foram realizados três ensaios para determinar os níveis nutricionais de fósforo disponível (Pd) para machos e fêmeas da linhagem ISA Label nas fases inicial (1 a 28 dias), crescimento (28 a 56 dias) e final (56 a 84 dias) criadas em semiconfinamento. em cada ensaio, 480 aves com idade correspondente à fase de criação foram alojadas em 24 unidades experimentais contendo áreas de abrigo e de pastejo. O delineamento experimental utilizado foi o inteiramente casualizado, em esquema fatorial 4 × 2 (níveis de Pd e sexos) com três repetições de 20 aves. Os níveis de fósforo disponível avaliados foram: 0,25; 0,36; 0,47 e 0,58% na fase inicial; 0,18; 0,31; 0,44 e 0,57% na fase de crescimento; e 0,14; 0,27; 0,40 e 0,53% na fase final. Foram avaliados o ganho de peso, consumo de ração, consumo de Pd, conversão alimentar, teores de fósforo, cálcio e cinzas na tíbia e resistência à quebra óssea. de acordo com os resultados, o nível ótimo de Pd na ração na fase inicial, para machos e fêmeas são de 0,39 e 0,49%, que correspondem ao consumo de 3,94 e 3,96 g de Pd/ave, respectivamente. Para a fase de crescimento, recomenda-se 0,35% de Pd na ração para aves de ambos os sexos, que correspondem a consumo de 8,45 e 6,70 g de Pd/ave. Na fase final, recomendam-se os níveis de 0,32 e 0,30% de Pd, que correspondem a consumos de 12 e 9,5 g de Pd/ave para machos e fêmeas, respectivamente.

Análise e proposta de elaboração de rótulo de embalagem de agrotóxicos (herbicida) por meio de metodologia de design ergonômico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Exigências de lisina e de metionina+cistina digestíveis para aves de corte da linhagem ISA Label em sistemas semi-confinado

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Liquid crystal polymers: macromolecular design for enhanced performances

During this work, done mainly in the laboratories of the department of Industrial Chemistry and Materials of the University of Bologna but also in the laboratories of the Carnegie Mellon University in collaboration with prof. K. Matyjaszewski and at the university of Zaragoza in collaboration with prof. J. Barberá, was focused mainly on the synthesis and characterization of new functional polymeric materials. In the past years our group gained a deep knowledge about the photomodulation of azobenzene containing polymers. The aim of this thesis is to push forward the performances of these materials by the synthesis of well defined materials, in which, by a precise control over the macromolecular structures, better or even new functionality can be delivered to the synthesized material. For this purpose, besides the rich photochemistry of azoaromatic polymers that brings to the application, the control offered from the recent techniques of controlled radical polymerization, ATRP over all, gives an enormous range of opportunity for the developing of a new generation of functional materials whose properties are determinate not only by the chemical nature of the functional center (e.g. azoaromatic chromophore) but are tuned and even amplified by a synergy with the whole macromolecular structure. Old materials in new structures. In this contest the work of this thesis was focused mainly on the synthesis and characterization of well defined azoaromatic polymers in order to establish, for the first time, precise structure-properties correlation. In fact a series of well defined different azopolymers, chiral and achiral, with different molecular weight and highly monodisperse were synthesized and their properties were studied, in terms of photoexpansion and photomodulation of chirality. We were then able to study the influence of the macromolecular structure in terms of molecular weight and ramification on the studied properties. The huge amount of possibility offered by the tailoring of the macromolecular structure were exploited for the synthesis of new cholesteric photochromic polymers that can be used as a smart label for the certification of the thermal history of any thermosensitive product. Finally the ATRP synthesis allowed us to synthesize a total new class of material, named molecular brushes: a flat surface covered with an ultra thin layer of polymeric chain covalently bond onto the surface from one end. This new class of materials is of extreme interest as they offer the possibility to tune and manage the interaction of the surface with the environment. In this contest we synthesized both azoaromatic surfaces, growing directly the polymer from the surface, and mixed brushes: surfaces covered with incompatible macromolecules. Both type of surfaces acts as “smart” surfaces: the first it is able to move the orientation of a LC cell by simply photomodulation and, thanks to the robustness of the covalent bond, can be used as a command surface overcoming all the limitation due to the dewetting of the active layer. The second type of surface, functionalized by a grafting-to method, can self assemble the topmost layer responding to changed environmental conditions, exposing different functionality according to different environment.

Design, synthesis and application of ultrastable rylene dyes for fluorescent labeling of biomolecules

Studies of organic fluorescent dyes are experiencing a renaissance related to the increasing demands posed by new microscopy techniques for high resolution and high sensitivity. While in the last decade single molecule equipment and methodology has significantly advanced and in some cases reached theoretical limits (e.g. detectors approaching unity quantum yields) unstable emission from chromophores and photobleaching become more and more the bottleneck of the advancement and spreading of single-molecule fluorescence studies. The main goal of this work was the synthesis of fluorophores that are water-soluble, highly fluorescent in an aqueous environment, have a reactive group for attachment to a biomolecule and posses exceptional photostability. An approach towards highly fluorescent, water-soluble and monofunctional perylene-3,4,9,10-tetracarboxdiimide and terrylene-3,4:11,12-tetra carboxidiimide chromophores was presented. A new synthetic strategy for the desymmetrization of perylenetetracarboximides was elaborated; water-solubility was accomplished by introducing sulfonyl substituents in the phenoxy ring. Two strategies have been followed relying on either non-specific or site specific labeling. For this purpose a series of new water-soluble monofunctional perylene and terrylene dyes, bearing amine or carboxy group were prepared. The reactivity and photophysical properties of these new chromophores were studied in aqueous medium. The most suitable chromophores were further derivatized with amine or thiol reactive groups, suitable for chemical modification of proteins. The performance of the new fluorescent probes was assessed by single molecule enzyme tracking, in this case phospholipase acting on phospholipid supported layers. Phospholipase-1 (PLA-1) was labeled with N-hydroxysuccinimide ester functionalized perylene and terrylene derivatives. The purification of the conjugates was accomplished by novel convenient procedure for the removal of unreacted dye from labeled enzymes, which involves capturing excess dye with a solid support. This novel strategy for purification of bioconjugates allows convenient and fast separation of labeled proteins without the need for performing time consuming chromatographic or electrophoretic purification steps. The outstanding photostability of the dyes and, associated therewith, the extended survival times under strong illumination conditions allow a complete characterization of enzyme action on its natural substrates and even connecting enzyme mobility to catalytic activity. For site-specific attachment of the rylene dyes to proteins the chromophores were functionalized with thioesters or nitrilotriacetic acid groups. This allowed attachment of the emitters to the N-terminus of proteins by native chemical ligation or complexation with His-tagged polypeptides at the N- or C-termini, respectively. The synthesis of a water-soluble perylenebis (dicarboximide) functionalized with a thioester group was presented. This chromophore exhibits an exceptional photostability and a functional unit for site-specific labeling of proteins. The suitability of the fluorophore as a covalent label was demonstrated via native chemical ligation with protein containing N-terminal cystein residue. We exploited also oligohisitidine sequences as recognition elements for site-selective labeling. The synthesis of a new water-soluble perylene chromophore, containing a nitrilotriacetic acid functional group was demonstrated, using solution-phase and solid-phase approaches. This chromophore combines the exceptional photophysical properties of the rylene dyes and a recognition unit for site-specific labeling of proteins. An important feature of the label is the unchanged emission of the dye upon complexation with nickel ions.

A review of antithrombotic therapy and the rationale and design of the randomized edoxaban in patients with peripheral artery disease (ePAD) trial adding edoxaban or clopidogrel to aspirin after femoropopliteal endovascular intervention.

Compared with the coronary setting, knowledge about antithrombotic therapies after endovascular treatment (EVT) is inadequate in patients with peripheral artery disease (PAD). Based on a review of trials and guidelines, which is summarized in this article, there is scant evidence that antithrombotic drugs improve outcome after peripheral EVT. To address this knowledge gap, the randomized, open-label, multinational edoxaban in patients with Peripheral Artery Disease (ePAD) study (ClinicalTrials.gov identifier NCT01802775) was designed to explore the safety and efficacy of a combined regimen of antiplatelet therapy with clopidogrel and anticoagulation with edoxaban, a selective and direct factor Xa inhibitor, both combined with aspirin. As of July 2014, 203 patients (144 men; mean age 67 years) from 7 countries have been enrolled. These patients have been allocated to once-daily edoxaban [60 mg for 3 months (or 30 mg in the presence of factors associated with increased exposure)] or clopidogrel (75 mg/d for 3 months). All patients received aspirin (100 mg/d) for the 6-month duration of the study. The primary safety endpoint is major or clinically relevant nonmajor bleeding; the primary efficacy endpoint is restenosis or reocclusion at the treated segment(s) measured at 1, 3, and 6 months using duplex ultrasound scanning. All outcomes will be assessed and adjudicated centrally in a masked fashion. The ePAD study is the first of its kind to investigate a combined regimen of antiplatelet therapy and anticoagulation through factor Xa inhibition with edoxaban.