Efficacy response in CF patients treated with ivacaftor: Post-hoc analysis

Clinical studies in patients with cystic fibrosis and G551D-CFTR showed that the group treated with ivacaftor had improved clinical outcomes. To better understand the effect of ivacaftor therapy across the distribution of individual FEV1 responses, data from Phase 3 studies (STRIVE/ENVISION) were re-examined. In this post-hoc analysis of patients (n=209) who received 48 weeks of ivacaftor or placebo, patients were assigned to tertiles according to FEV1 response. These groups were then used to evaluate response (FEV1, sweat chloride, weight, CFQ-R, and pulmonary exacerbation). The number needed to treat (NNT) was calculated for specific thresholds for each outcome. Across all tertiles, numerical improvements in FEV1, sweat chloride, CFQ-R and the frequency of pulmonary exacerbations were observed in ivacaftor-treated patients: the treatment difference versus placebo was statistically significant for all outcomes in the upper tertile and for some outcomes in the lower and middle tertiles. The NNT for a≥5% improvement in %predicted FEV1 was 1.90, for a≥5% body weight increase was 5.74, and to prevent a pulmonary exacerbation was 3.85. This analysis suggests that the majority of patients with clinical characteristics similar to STRIVE/ENVISION patients have the potential to benefit from ivacaftor therapy.

Long-term macrolide maintenance therapy in non-CF bronchiectasis: Evidence and questions

Phenotypic characterization of an international Pseudomonas aeruginosa reference panel: strains of cystic fibrosis (CF) origin show less in vivo virulence than non-CF strains

Pseudomonas aeruginosa causes chronic lung infections in people with cystic fibrosis (CF) and acute opportunistic infections in people without CF. Forty two P. aeruginosa strains from a range of clinical and environmental sources were collated into a single reference strain panel to harmonise research on this diverse opportunistic pathogen. To facilitate further harmonized and comparable research on P. aeruginosa, we characterised the panel strains for growth rates, motility, virulence in the Galleria mellonella infection model, pyocyanin and alginate production, mucoid phenotype, lipopolysaccharide (LPS) pattern, biofilm formation, urease activity, antimicrobial and phage susceptibilities. Phenotypic diversity across the P. aeruginosa panel was apparent for all phenotypes examined agreeing with the marked variability seen in this species. However, except for growth rate, the phenotypic diversity among strains from CF versus non-CF sources was comparable. CF strains were less virulent in the G. mellonella model than non-CF strains (p=0.037). Transmissible CF strains generally lacked O antigen, produced less pyocyanin, and had low virulence in G. mellonella. Further, in the three sets of sequential CF strains, virulence, O-antigen expression and pyocyanin production were higher in the earlier isolate compared to the isolate obtained later in infection. Overall, full phenotypic characterization of the defined panel of P. aeruginosa strains increases our understanding of the virulence and pathogenesis of P. aeruginosa and may provide a valuable resource for the testing of novel therapies against this problematic pathogen.

Chemical and microbial changes during the natural fermentation of strawberry tree (Arbutus unedo L.) fruits

Aguardente de medronho is the name given in Portugal to a spirit made from the fermented fruit of Arbutus unedo (strawberry tree), a plant grown in the Mediterranean region. In order to gain a better understanding of the fermentation process, as it is performed in the farms, a natural fermentation with wild microbiota was carried out during 36 days, and some physicochemical and microbiological parameters were studied. The microbial parameters analyzed were total viable, lactic and acetic acids bacteria, and yeast counts. The physicochemical parameters monitored were sugars, minerals, ethanol, organic acids and pH. Yeasts were the main responsible for the fermentation of the fruits, as the lactic and acetic acids bacteria are absent. As the fermentation progressed, the sugars increased during the first 2 days and gradually decreased along the fermentation period. Maintaining the good quality of the product could contribute to the preservation and valorization of traditional resources that are of great importance to prevent their disappearance.

Yeast diversity in the Mediterranean strawberry tree (Arbutus unedo L.) fruits' fermentations

In the Mediterranean region the fruits of the strawberry tree (Arbutus unedo L.) may be fermented and distilled to produce a traditional beverage very much appreciated in Southern Europe. The aim of the present work was to study the diversity of the yeast population and the killer activity of the isolates identified as Saccharomyces cerevisiae, obtained during solid state industrial fermentations of the arbutus berries. The identification of the isolates was performed by the 5.8S rRNA-ITS region restriction analysis and by sequencing the D1/D2 region of the large subunit of the rRNA gene. At the start of the fermentations, various non-Saccharomyces species were detected including Aureobasidium pullulans, Dothichiza pithyophila, Dioszegia zsoltii, Hanseniaspora uvarum and yeasts belonging to the genera Metschnikowia, Cryptococcus and Rhodotorula. However, as the biological processes progressed the number of different species decreased with S. cerevisiae and Pichia membranaefaciens becoming dominant at advanced stages of the must fermentation that is characterized by high concentrations of ethanol. Forty three isolates identified as S. cerevisiae were tested for killer activity against two sensitive reference strains and Zygosaccharomyces bailii. Their killer sensitivity in relation to five killer referenced toxins (K2, K5, K8, K9 and K10) was also studied. Out of the isolates analyzed, 95.3% were sensitive and 4.7% were tolerant against the killer toxins tested. Only three isolates revealed killer activity against one sensitive strain and two of them against the spoiler yeast Z. bailii. The microbiota obtained revealed an interesting potential to be used as starter cultures to overcome unpredictable uncontrolled fermentations of the arbutus fruits as well as in other applications of biotechnological interest. (C) 2012 Elsevier Ltd. All rights reserved.

The Long Range Transport of Birch (Betula) Pollen from Poland and Germany Causes Significant Pre-season Concentrations in Denmark

Background Birch pollen is highly allergic and has the potential for episodically long range transport. Such episodes will in general occur out of the main pollen season. During that time allergy patients are unprotected and high pollen concentrations will therefore have a full allergenic impact. Objective To show that Denmark obtains significant quantities of birch pollen from Poland or Germany before the local trees start to flower. Methods Simultaneous observations of pollen concentrations and phenology in the potential source area in Poland as well as in Denmark were performed in 2006. The Danish pollen records from 2000-2006 were analysed for possible long range transport episodes and analysed with trajectories in combination with a birch tree source map. Results In 2006 high pollen concentrations were observed in Denmark with bi-hourly concentrations above 500 grains/ m3 before the local trees began to flower. Poland was identified as a source region. The analysis of the historical pollen record from Copenhagen shows significant pre-seasonal pollen episodes almost every year from 2000-2006. In all episodes trajectory analysis identified Germany or Poland as source regions. Conclusion Denmark obtains significant pre-seasonal quantities of birch pollen from either Poland or Germany almost every year. Forecasting of birch pollen quantities relevant to allergy patients must therefore take into account long-range transport. This cannot be based on measured concentrations in Denmark. The most effective way to improve the current Danish pollen forecasts is to extend the current forecasts with atmospheric transport models that take into account pollen emission and transport from countries such as Germany and Poland. Unless long range transport is taken into account pre-seasonal pollen episodes will have a full allergic impact, as the allergy patients in general will be unprotected during that time.

Factors that Determine the Severity of Betula spp. Pollen Seasons in Poland (Poznań and Krakow) and the United Kingdom (Worcester and London)

The aim of this paper is to analyse variations in the severity of Betula pollen seasons, particularly in relation to meteorological parameters at four sites, Poznań and Krakow in Poland and Worcester and London in the United Kingdom. Results show that there is a significant relationship between Betula pollen season severity and weather conditions in the year before pollination as well as conditions in the same year that pollen is released from the plant. Furthermore, it is likely that the magnitude of birch pollen seasons in Poznań, Worcester and London is linked in some way to different phases of the North Atlantic Oscillation (NAO). Significant positive relationships exist between birch pollen counts at Poznań and temperatures, rainfall and averages of the NAO in the year before pollination. An opposite relationship is evident at the two sites studied in the British Isles. There were significant positive correlations between the severity of birch pollen seasons recorded at Worcester and London and temperatures and averages of the NAO during the year of pollination, and negative correlations with similar variables from the previous year. In addition, Betula pollen seasons in Krakow do not appear to be influenced by the NAO, which is probably the result of Krakow having a more continental climate.

Are the Birch Trees in Southern England a Source of Betula Pollen for North London?

Birch pollen is highly allergenic. Knowledge of daily variations, atmospheric transport and source areas of birch pollen is important for exposure studies and for warnings to the public, especially for large cities such as London. Our results show that broad-leaved forests with high birch tree densities are located to the south and west of London. Bi-hourly Betula pollen concentrations for all the days included in the study, and for all available days with high birch pollen counts (daily average birch pollen counts >80 grains/m3), show that, on average, there is a peak between 1400 hours and 1600 hours. Back-trajectory analysis showed that, on days with high birch pollen counts (n=60), 80% of air masses arriving at the time of peak diurnal birch pollen count approached North London from the south in a 180 degree arc from due east to due west. Detailed investigations of three Betula pollen episodes, with distinctly different diurnal patterns compared to the mean daily cycle, were used to illustrate how night-time maxima (2200–0400 hours) in Betula pollen counts could be the result of transport from distant sources or long transport times caused by slow moving air masses. We conclude that the Betula pollen recorded in North London could originate from sources found to the west and south of the city and not just trees within London itself. Possible sources outside the city include Continental Europe and the Betula trees within the broad-leaved forests of Southern England.