Evaluation of Long-Term Outcomes, Cytogenetic and Molecular Responses with Imatinib Mesylate in Early and Late Chronic-Phase Chronic Myeloid Leukemia: A Report from a Single Institute

Here we compare the management and survival outcomes of chronic myeloid leukemia (CML) patients who had early or late imatinib mesylate (IM) therapy. The cytogenetic and molecular responses of 189 CML patients were analyzed. Of this group, 121 patients were classified as the early chronic phase (ECP) group and started IM within 12 months of diagnosis. The other 68 patients were classified as the late chronic phase (LCP) group who had been treated with interferon (IFN)-alpha-2 and crossed over to IM more than 12 months after diagnosis. The overall rates of complete cytogenetic response (CCyR) and major molecular response (MMR) at last follow-up were 83.6 and 78.1% in the ECP and LCP groups, respectively. The CCyR rates were 89.3 (for ECP patients) versus 73.5% (for LCP patients; p < 0.0001). At last follow-up, 82.4% ECP and 64.2% LCP patients had achieved an MMR (p < 0.0001). No significant differences were noted between the two groups with regard to survival outcomes. Our experience reveals that IM is an effective rescue therapy in most CML LCP patients who are intolerant or in whom IFN-alpha therapy fails. Such therapeutic options should be considered in LCP patients, particularly in countries where IM may not be available. Copyright (C) 2012 S. Karger AG, Basel

Molecular measurement of BCR-ABL transcript variations in chronic myeloid leukemia patients in cytogenetic remission

Abstract Background The monitoring of BCR-ABL transcript levels by real-time quantitative polymerase chain reaction (RT-qPCR) has become important to assess minimal residual disease (MRD) and standard of care in the treatment of chronic myeloid leukemia (CML). In this study, we performed a prospective, sequential analysis using RT-qPCR monitoring of BCR-ABL gene rearrangements in blood samples from 91 CML patients in chronic phase (CP) who achieved complete cytogenetic remission (CCyR) and major molecular remission (MMR) throughout imatinib treatment. Methods The absolute level of BCR-ABL transcript from peripheral blood was serially measured every 4 to 12 weeks by RT-qPCR. Only level variations > 0.5%, according to the international scale, was considered positive. Sequential cytogenetic analysis was also performed in bone marrow samples from all patients using standard protocols. Results Based on sequential analysis of BCR-ABL transcripts, the 91 patients were divided into three categories: (A) 57 (62.6%) had no variation on sequential analysis; (B) 30 (32.9%) had a single positive variation result obtained in a single sample; and (C) 4 (4.39%) had variations of BCR-ABL transcripts in at least two consecutive samples. Of the 34 patients who had elevated levels of transcripts (group B and C), 19 (55.8%) had a < 1% of BCR-ABL/BCR ratio, 13 (38.2%) patients had a 1% to 10% increase and 2 patients had a >10% increase of RT-qPCR. The last two patients had lost a CCyR, and none of them showed mutations in the ABL gene. Transient cytogenetic alterations in Ph-negative cells were observed in five (5.5%) patients, and none of whom lost CCyR. Conclusions Despite an increase levels of BCR-ABL/BCR ratio variations by RT-qPCR, the majority of CML patients with MMR remained in CCyR. Thus, such single variations should neither be considered predictive of subsequent failure and nor an indication for altering imatinib dose or switching to second generation therapy. Changing of imatinib on the basis of BCR-ABL/BCR% sustained increase and mutational studies is a prudent approach for preserving other therapeutic options in imatinib-resistant patients.

Mercury-induced autoimmunity : Genetics and immunoregulation

The existence of immune self-tolerance allows the immune system to mount responses against infectious agents, but not against self-molecular constitutes. Although self-tolerance is a robust phenomenon, in some individuals as well as in experimental models, the self-tolerance breaks down and as a result, a self-destructive autoimmune disease emerges. The underlying mechanisms for the development of autoimmune diseases are not known, but genetic, environmental and immunological factors are suggested to be involved. In this thesis, we used murine mercury-induced autoimmunity to test this suggestion. In susceptible mice mercuric chloride induces a systemic autoimmune disease characterized by increased serum levels of IgG1 and IgE, production of anti-nucleolar autoantibodies (ANolA) and formation of renal IgG deposits. In contrast, in resistant DBA/2 (H-2d) mice, none of these characteristics develop after exposure to mercury. By crossing and backcrossing mercury-resistant DBA/2 mice to mercury susceptible strains, we found that the resistance was inherited as a dominant trait in F1 hybrids and that one gene or a cluster of genes located in the H-2 loci determined the resistance to ANolA production, whereas resistance to the other characteristics was found to be controlled by two or three non-H-2 genes. We further put forward the “cryptic peptide hypothesis” to investigate whether mercury and another xenobiotic metal use similar pathway(s) to induce the H-2 linked production of ANolA. We found that while mercury stimulated ANolA synthesis in all H-2 susceptible (H-2s, H-2q and H-2f) mouse strains, silver induced only ANolA responses in H-2s and H-2q mice, but not in H-2f mice. Further studies showed that the resistance to silver-induced ANolA production in H-2f mice was inherited as a dominant trait. We next tested the proposition that mercury induces more adverse immunological effects in mouse strains, which are genetically prone to develop autoimmune diseases, using tight-skin 1 mice, an animal model for human Scleroderma. It was found that in this strain, mercury induced a strong immune activation with autoimmune characteristics, but did not accelerate the development of dermal fibrosis, a characteristic in Tsk/1 mice. Finally we addressed the Th1/Th2 cross-regulation paradigm by examining if a Th1-type of response could interact with a Th2-type of response if simultaneous induced in susceptible mice. Our findings demonstrated that mercury-induced autoimmunity (Th2-type) and collagen-induced arthritis (CIA) (Th1-type) can interact in a synergistic, antagonistic or additive fashion, depending on at which stage of CIA mercury is administered.

Il trattamento delle fratture e lussazioni vertebrali nei piccoli animali

Treatment of spinal fracture and luxation in small animals Traumatic spinal injuries usually result from a mechanic trauma. Spinal facture and luxations generally occur in the junction between and more mobile parts of the spinal column: close to the skull, thorax and pelvis. Fractures may occur alone or in combination with luxation as fracture/luxation. When the fractures are not stable the best solution is the surgical fixation. Internal and external fixation are the surgical methods for the treatment of vertebral fractures and luxations. The authors report the treatment of 12 cases of thoracic and lumbar vertebral fractures and luxations in small animals using the screws/pins and Polymethylmethacrylate technique. The analysis of results is a contribute I the valutation of surgical technique and complications in the post-surgical period.

Macchine esperienziali: Narrativa, cognizione e atto di lettura

La mia tesi si riallaccia al dibattito teorico-letterario contemporaneo sulla possibilità di un approccio cognitivo alla narrativa e alla letteratura in particolare. Essa si propone di esplorare il rapporto tra narrazione ed esperienza, ridefinendo il concetto di “esperienzialità” della narrativa introdotto da Monika Fludernik nel suo Towards a “Natural” Narratology (1996). A differenza di Fludernik, che ha identificato l’esperienzialità con la rappresentazione dell’esperienza dei personaggi, la mia trattazione assegna un ruolo di primo piano al lettore, cercando di rispondere alla domanda: perché leggere una storia è – o si costituisce come – un’esperienza? L’intuizione dietro tutto ciò è che le teorizzazioni dell’esperienza e della coscienza nella filosofia della mente degli ultimi venti anni possano gettare luce sull’interazione tra lettori e testi narrativi. Il mio punto di riferimento principale è la scienza cognitiva “di seconda generazione”, secondo cui l’esperienza è un relazionarsi attivo e corporeo al mondo. La prima parte del mio studio è dedicata all’intreccio tra la narrativa e quello che chiamo lo “sfondo esperienziale” di ogni lettore, un repertorio di esperienze già note ai lettori attraverso ripetute interazioni con il mondo fisico e socio-culturale. Mi soffermo inoltre sul modo in cui relazionarsi a un testo narrativo può causare cambiamenti e slittamenti in questo sfondo esperienziale, incidendo sulla visione del mondo del lettore. Mi rivolgo poi al coinvolgimento corporeo del lettore, mostrando che la narrativa può attingere allo sfondo esperienziale dei suoi fruitori anche sul piano dell’esperienza di base: le simulazioni corporee della percezione contribuiscono alla nostra comprensione delle storie, incidendo sia sulla ricostruzione dello spazio dell’ambientazione sia sulla relazione intersoggettiva tra lettori e personaggi. Infine, mi occupo del rapporto tra l’esperienza della lettura e la pratica critico-letteraria dell’interpretazione, sostenendo che – lungi dal costituire due modalità opposte di fruizione dei testi – esse sono intimamente connesse.

Molekulare Mechanismen der Kontaktinhibition: Identifizierung neuer Tumorsuppressorgene

Die Zellen eines Organismus unterliegen ständig den Einflüssen wachstumsfördernder und –hemmender Signale. Die korrekte Verarbeitung dieser Signale ist essentiell für die Aufrechterhaltung der Gewebehomöostase. Wachstumsfördernde Signale sind z. B. Wachstumsfaktoren und –hormone. Diese Substanzen sowie ihre Rezeptoren und Signalwege sind relativ gut erforscht. Dagegen ist über die wachstumshemmenden Signalwege vergleichsweise wenig bekannt. Wichtige wachstumshemmende Signale werden einerseits über lösliche Faktoren, wie z. B. TGF-β, und andererseits über Zell-Zell-Kontakte vermittelt. Den Zell-Zell-Kontakt vermittelten Wachstumsstopp bezeichnet man auch als Kontaktinhibition. Die Kontaktinhibition ist ein wichtiges Merkmal nicht-transformierter Zellen. Im Gegensatz dazu zeichnen sich transformierte Zellen durch den Verlust der Kontaktinhibition aus, der einhergeht mit unkontrolliertem Wachstum der Zellen und Tumorbildung. Genauere Kenntnisse der molekularen Ursachen der Kontaktinhibition bzw. ihres Verlustes während der Tumorentstehung werden neue Ansatzpunkte für die Krebstherapie liefern. Diese können bei der Entwicklung neuer, nebenwirkungsärmerer Krebsmedikamente und einer verbesserten Diagnostik helfen. In der vorliegenden Arbeit sollten daher die molekularen Mechanismen der Kontaktinhibition in Fibroblasten aus der Maus näher untersucht werden. Dazu wurden differentielle Genexpressionsanalysen mittels genomweiter Microarrays durchgeführt. Weiterhin wurde der Einfluss der Kontaktinhibition auf die Regulation der Signalkaskaden der MAP-Kinasen ERK und p38 untersucht. Durch die Genexpressionsanalyse konnte gezeigt werden, dass viele Schlüsselgene des Zellzyklus und der DNA-Synthese in der Kontaktinhibition eine Rolle spielen, so zum Beispiel Skp2, Foxm1 und einige Komponenten des MCM-Komplexes. Weiterhin haben wir gezeigt, dass durch Kontaktinhibition selektiv die EGF-induzierte Signalkaskade über die MAP-Kinasen gehemmt wird.

Nuclear charge radii of light isotopes based on frequency comb measurements

Optical frequency comb technology has been used in this work for the first time to investigate the nuclear structure of light radioactive isotopes. Therefore, three laser systems were stabilized with different techniques to accurately known optical frequencies and used in two specialized experiments. Absolute transition frequency measurements of lithium and beryllium isotopes were performed with accuracy on the order of 10^(−10). Such a high accuracy is required for the light elements since the nuclear volume effect has only a 10^(−9) contribution to the total transition frequency. For beryllium, the isotope shift was determined with an accuracy that is sufficient to extract information about the proton distribution inside the nucleus. A Doppler-free two-photon spectroscopy on the stable lithium isotopes (6,7)^Li was performed in order to determine the absolute frequency of the 2S → 3S transition. The achieved relative accuracy of 2×10^(−10) is improved by one order of magnitude compared to previous measurements. The results provide an opportunity to determine the nuclear charge radius of the stable and short-lived isotopes in a pure optical way but this requires an improvement of the theoretical calculations by two orders of magnitude. The second experiment presented here was performed at ISOLDE/CERN, where the absolute transition frequencies of the D1 and D2 lines in beryllium ions for the isotopes (7,9,10,11)^Be were measured with an accuracy of about 1 MHz. Therefore, an advanced collinear laser spectroscopy technique involving two counter-propagating frequency-stabilized laser beams with a known absolute frequency was developed. The extracted isotope shifts were combined with recent accurate mass shift calculations and the root-mean square nuclear charge radii of (7,10)^Be and the one-neutron halo nucleus 11^Be were determined. Obtained charge radii are decreasing from 7^Be to 10^Be and increasing again for 11^Be. While the monotone decrease can be explained by a nucleon clustering inside the nucleus, the pronounced increase between 10^Be and 11^Be can be interpreted as a combination of two contributions: the center-of-mass motion of the 10^Be core and a change of intrinsic structure of the core. To disentangle these two contributions, the results from nuclear reaction measurements were used and indicate that the center-of-mass motion is the dominant effect. Additionally, the splitting isotope shift, i.e. the difference in the isotope shifts between the D1 and D2 fine structure transitions, was determined. This shows a good consistency with the theoretical calculations and provides a valuable check of the beryllium experiment.

Beeinflusst die Stärke der Stressreaktion in der Post-Akquisitionsphase das Identitätsgedächtnis von Gesichtern?

Stress in der Post-Akquisitionsphase begünstigt die Gedächtniskonsolidierung emotional erregender Informationen. Das Zusammenspiel von noradrenerger Aktivierung und Cortisol auf Ebene der Amygdala ist hierbei von entscheidender Bedeutung. rnIn dieser Studie wird untersucht, ob dieser Effekt durch das Ausmaß der kardiovaskulären bzw. der subjektiv erlebten Stressreaktivität beeinflusst wird. 49 Probanden (Alter: 23.8 Jahre; 32 Frauen) wurden je 52 Gesichter, davon 50% mit ärgerlichem sowie 50 % mit glücklichem Ausdruck präsentiert. Sofort nach Akquisition wurde bei 30 Probanden akuter Stress durch den sozial evaluierten Kaltwassertest (SECPT; Eintauchen der dominanten Hand in eiskaltes Wasser für 3 Minuten unter Beobachtung) induziert, bei 19 Probanden wurde eine Kontrollprozedur ohne Stress durchgeführt. Die 30 Probanden der SECPT-Gruppe wurden post-hoc zum einen anhand der individuellen Blutdruckreaktivität und zum zweiten anhand der Stärke der subjektiv bewerteten Stressreaktivität per Mediansplit in zwei Subgrupen unterteilt (High Responder, Low Responder). rnDer erste Wiedererkennungstest fand 30 Minuten nach der Akquisitionsphase, ein weiterer 20 Stunden später statt. Zu den Testzeitpunkten wurden jeweils 26 der initial präsentierten Gesichter mit neutralem Gesichtsausdruck gezeigt sowie 26 neue neutrale Gesichter. rnDie Kontrollgruppe und die Gruppe der High Responder (basierend auf der kardiovaskulären Reaktivität) zeigten ein besseres Erinnerungsvermögen für die initial positiv präsentierten gesichter, wohingegen die Gruppe der Low Responder ein besseres Gedächtnis für die initial negativ präsentierten Gesichter aufwies. rnStress scheint abhängig von der Stärke der kardiovaskulären Reaktion zu valenzspezifischen Konsolidierungseffekten zu führen. Hierbei könnten viszerale Afferenzen z.B. der arteriellen Baroreflexe eine Rolle spielen. rn

Leberregeneration bei fortgeschrittener Leberzirrhose : Untersuchung Albumin-exprimierender Gallengangsproliferate mittels In-situ-Hybridisierung

Die Leber besitzt das Potential nach verursachter Zellschädigung durch chemische, toxische, traumatische oder virale Einwirkung (55, 73, 79, 95) sich selbst zu regenerieren. Dies geschieht entweder durch Hyperplasie der Hepatozyten, d.h. einer Volumenzunahme durch vermehrte Zellteilung und Erhöhung der Zellzahl (73, 79). Bei massiver und chronischer Leberzellschädigung, wie z.B. alkohol-verursachter Leberzirrhose oder durch chronisch virale Hepatitis (55, 74, 81) können die Hepatozyten den entstandenen Defekt nicht kompensieren und die oval cells, Bezeichnung im Rahmen der Nagetiermodelle, werden aktiviert (98, 105). Das humane Equivalent zu den oval cells bei Nagetieren stellen die hepatischen Progenitorzellen dar (79), diese sind in den Hering-Kanälchen lokalisiert (1, 42, 49). Aufgrund ihrer bipotenten Differenzierungsfähigkeit, können aus den hepatischen Progenitorzellen sowohl Hepatozyten als auch Cholangiozyten hervorgehen (18, 45). rnFür die Untersuchungen einer positiven Albumin-mRNA-Expression in Gallengangsproliferaten bei menschlichen zirrhotischen Leberpräparaten, die im Rahmen der Leberregeneration aus hepatischen Progenitorzellen entstehen, bietet sich das bereits etablierte Verfahren der Albumin mRNA in situ Hybridisierung an. Zur Durchführung der Methode wurde ein bereits etabliertes Protokoll zur in situ Hybridiserung von mRNAs peroxisomaler Proteine verwendet (86, 87).rnDas Patientenkollektiv bestand aus insgesamt 50 Patienten (9 weiblichen und 41 männlichen), im Alter von 40 bis 69 Jahren (Median=53, 25 %-Perzentile=49, 75%-Perzentile=60). Sieben Patienten zeigten eine Leberzirrhose auf dem Boden einer Hepatitis B, 24 Patienten eine Leberzirrhose auf dem Boden einer Hepatitis C und 19 Patienten waren an einer äthyltoxisch-bedingten Leberzirrhose erkrankt. Zusätzlich wurde bei insgesamt 23 Patienten im Rahmen der histologischen Befundung ein Hepatozelluläres Karzinom (HCC) diagnostiziert. rnMikroskopisch zeigte sich in 48 von 50 Präparaten eine Gallengangsproliferation innerhalb der bindegewebigen Septen. Bei Vorliegen einer Gallengangsproliferation wurde deren Ausprägung in 4 Grade (0=keine, 1=wenig, 2=mäßig und 3=stark) eingeteilt. Ein möglicher signifikanter Unterschied, ob der Grad einer Gallengangsproliferation auf eine bestimmte Ursache der Leberzirrhose zurück zu führen ist, ließ sich mit einem p-Wert von 0,247 nicht eruieren. Ebenso wie die Gallengansproliferation wurde die Albuminexpression in Grade eingeteilt. Dabei wurde zwischen keiner (Grad 0), einer intermediären (Grad 1) und einer starken (Grad 2) Albuminexpression unterschieden. Hier waren mit einem p-Wert von 0,586 keine Unterschiede zwischen der Gradeinteilung der Albuminexpression und den 3 Gruppen zu erkennen.rnZwischen den Präparaten mit einem HCC und ohne HCC ergaben sich hinsichtlich des Grades der Gallengangsproliferation mit einem p-Wert von 0,803 keine signifikanten Unterschiede. In Bezug auf die Gradeinteilung der Albuminexpressionrnzeigte sich ebenfalls kein signifikanter Unterschied mit einem p-Wert von 0,275 zwischen Präparaten mit und ohne Nachweis eines HCCs. Ebenfalls zeigte sich kein signifikanter Unterschied zwischen der Gallengangsproliferation (p-Wert von 0,709) und Albuminexpression (p-Wert von 0,613) zwischen Patienten jünger und älter als 60 Jahre.rnDie Ergebnisse dieser Arbeit zeigen, dass mittels der in situ Hybridisierung ein Nachweis der Gallengangsproliferation in leberzirrhotischen Präparaten unterschiedlicher Ätiologien gelingt. Zudem kann diese Arbeit beweisen, dass die Gallengangsproliferate Albumin exprimieren und dass der Nachweis dieser Albuminexpression mittels in situ Hybridisierung möglich ist. Allerdings zeigte sich kein signifikanter Unterschied der Albumin-mRNA-Expression in den Gallengangsproliferaten zwischen den unterschiedlichen Ätiologien der Leberzirrhose und ebenfalls nicht im Vergleich von Leberzirrhosen unterschiedlicher Genese mit und ohne gleichzeitigem Nachweis eines HCCs. rn

Antifibrotic effects of tocotrienols on human Tenon's fibroblasts

Antifibrotic effects of α- (40, 60, 80, 100, and 120 μM), γ- (10, 20, 30, and 40 μM) and δ-tocotrienol (10, 20, 30, and 40 μM) on hTf cultures were evaluated by performing proliferation, migration and collagen synthesis assays. Whereas for vitamin E the exposure time was set to 7 days to mimic subconjunctival application, cultures were exposed only 5 min to mitomycin C 100 μg/ml to mimic intraoperative administration. Cell morphology (phase contrast microscopy) as an assessment for cytotoxicity and cell density by measuring DNA content in a fluorometric assay to determine proliferation inhibition was performed on day 0, 4, and 7. Migration ability and collagen synthesis of fibroblasts were measured. Results All tested tocotrienol isoforms were able to significantly inhibit hTf proliferation in a dose-dependent manner (maximal inhibitory effect without relevant morphological changes at day 4 for α-tocotrienol 80 μM with 36.7% and at day 7 for α-tocotrienol 80 μM with 42.6% compared to control). Degenerative cell changes were observed in cultures with concentrations above 80 μM for α- and above 30 μM for γ- and δ-tocotrienol. The highest collagen synthesis inhibition has been found with 80 µM α-tocotrienol (62.4%) and no significant inhibition for mitomycin C (2.5%). Migration ability was significantly reduced in cultures exposed to 80 µM α- and 30 µM γ-tocotrienol (inhibition of 82.2% and 79.5%, respectively, compared to control) and also after mitomycin C treatment (60.0%). Complete growth inhibition without significant degenerative cell changes could only be achieved with mitomycin C. Conclusion In vitro, all tested tocotrienol isoforms were able to inhibit proliferation, migration and collagen synthesis of human Tenon’s fibroblasts and therefore may have the potential as an anti-scarring agent in filtrating glaucoma surger

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis

In patients with HIV-1 infection who are starting combination antiretroviral therapy (ART), the incidence of immune reconstitution inflammatory syndrome (IRIS) is not well defined. We did a meta-analysis to establish the incidence and lethality of the syndrome in patients with a range of previously diagnosed opportunistic infections, and examined the relation between occurrence and the degree of immunodeficiency. Systematic review identified 54 cohort studies of 13 103 patients starting ART, of whom 1699 developed IRIS. We calculated pooled cumulative incidences with 95% credibility intervals (CrI) by Bayesian methods and did a random-effects metaregression to analyse the relation between CD4 cell count and incidence of IRIS. In patients with previously diagnosed AIDS-defining illnesses, IRIS developed in 37.7% (95% CrI 26.6-49.4) of those with cytomegalovirus retinitis, 19.5% (6.7-44.8) of those with cryptococcal meningitis, 15.7% (9.7-24.5) of those with tuberculosis, 16.7% (2.3-50.7) of those with progressive multifocal leukoencephalopathy, and 6.4% (1.2-24.7) of those with Kaposi's sarcoma, and 12.2% (6.8-19.6) of those with herpes zoster. 16.1% (11.1-22.9) of unselected patients starting ART developed any type of IRIS. 4.5% (2.1-8.6) of patients with any type of IRIS died, 3.2% (0.7-9.2) of those with tuberculosis-associated IRIS died, and 20.8% (5.0-52.7) of those with cryptococcal meningitis died. Metaregression analyses showed that the risk of IRIS is associated with CD4 cell count at the start of ART, with a high risk in patients with fewer than 50 cells per microL. Occurrence of IRIS might therefore be reduced by initiation of ART before immunodeficiency becomes advanced.

Phase I/IIa study of cilengitide and temozolomide with concomitant radiotherapy followed by cilengitide and temozolomide maintenance therapy in patients with newly diagnosed glioblastoma

Invasion and migration are key processes of glioblastoma and are tightly linked to tumor recurrence. Integrin inhibition using cilengitide has shown synergy with chemotherapy and radiotherapy in vitro and promising activity in recurrent glioblastoma. This multicenter, phase I/IIa study investigated the efficacy and safety of cilengitide in combination with standard chemoradiotherapy in newly diagnosed glioblastoma.