Safety, pharmacokinetics, and antiretroviral activity of multiple doses of ibalizumab (formerly TNX-355), an anti-CD4 monoclonal antibody in HIV-1 infected adults

Context: Despite tremendous strides in HIV treatment over the past decade, resistance remains a major problem. A growing number of patients develop resistance and require new therapies to suppress viral replication. ^ Objective: To assess the safety of multiple administrations of the anti-CD4 receptor (anti-CD4) monoclonal antibody ibalizumab given as intravenous (IV) infusions, in three dosage regimens, in subjects infected with human immunodeficiency virus (HIV-1). ^ Design: Phase 1, multi-center, open-label, randomized clinical trial comparing the safety, pharmacokinetics and antiviral activity of three dosages of ibalizumab. ^ Setting: Six clinical trial sites in the United States. ^ Participants: A total of twenty-two HIV-positive patients on no anti-retroviral therapy or a stable failing regimen. ^ Intervention: Randomized to one of two treatment groups in Arms A and B followed by non-randomized enrollment in Arm C. Patients randomized to Arm A received 10 mg/kg of ibalizumab every 7 days, for a total of 10 doses; patients randomized to Arm B received a total of six doses of ibalizumab; a single loading dose of 10 mg/kg on Day 1 followed by five maintenance doses of 6 mg/kg every 14 days, starting at Week 1. Patients assigned to Arm C received 25 mg/kg of ibalizumab every 14 days for a total of 5 doses. All patients were followed for safety for an additional 7 to 8 weeks. ^ Main Outcome Measures: Clinical and laboratory assessments of safety and tolerability of multiple administrations of ibalizumab in HIV-infected patients. Secondary measures of efficacy include HIV-1 RNA (viral load) measurements. ^ Results: 21 patients were treatment-experienced and 1 was naïve to HIV therapy. Six patients were failing despite therapy and 15 were on no current HIV treatment. Mean baseline viral load (4.78 log 10; range 3.7-5.9) and CD4+ cell counts (332/μL; range 89-494) were similar across cohorts. Mean peak decreases in viral load from baseline of 0.99 log10(1.11 log10, and 0.96 log 10 occurred by Wk 2 in Cohorts A, B and C, respectively. Viral loads decreased by >1.0 log10 in 64%; 4 patients viral loads were suppressed to < 400 copies/mL. Viral loads returned towards baseline by Week 9 with reduced susceptibility to ibalizumab. CD4+ cell counts rose transiently and returned toward baseline. Maximum median elevations above BL in CD4+ cell counts for Cohorts A, B and C were +257, +198 and +103 cells/μL, respectively and occurred within 3 Wks in 16 of 22 subjects. The half-life of ibalizumab was 3-3.5 days and elimination was characteristic of capacity-limited kinetics. Administration of ibalizumab was well tolerated. Four serious adverse events were reported during the study. None of these events were related to study drug. Headache, nausea and cough were the most frequently reported treatment emergent adverse events and there were no laboratory abnormalities related to study drug. ^ Conclusions: Ibalizumab administered either weekly or bi-weekly was safe, well tolerated, and demonstrated antiviral activity. Further studies with ibalizumab in combination with standard antiretroviral treatments are warranted.^

THE USE OF MULTIVARIATE ANALYSIS OF COVARIANCE IN EVALUATING THE COMPARABILITY OF LABORATORY DETERMINATIONS IN COOPERATIVE STUDIES

The role of clinical chemistry has traditionally been to evaluate acutely ill or hospitalized patients. Traditional statistical methods have serious drawbacks in that they use univariate techniques. To demonstrate alternative methodology, a multivariate analysis of covariance model was developed and applied to the data from the Cooperative Study of Sickle Cell Disease.^ The purpose of developing the model for the laboratory data from the CSSCD was to evaluate the comparability of the results from the different clinics. Several variables were incorporated into the model in order to control for possible differences among the clinics that might confound any real laboratory differences.^ Differences for LDH, alkaline phosphatase and SGOT were identified which will necessitate adjustments by clinic whenever these data are used. In addition, aberrant clinic values for LDH, creatinine and BUN were also identified.^ The use of any statistical technique including multivariate analysis without thoughtful consideration may lead to spurious conclusions that may not be corrected for some time, if ever. However, the advantages of multivariate analysis far outweigh its potential problems. If its use increases as it should, the applicability to the analysis of laboratory data in prospective patient monitoring, quality control programs, and interpretation of data from cooperative studies could well have a major impact on the health and well being of a large number of individuals. ^

Evaluation of memory B cells among perinatally HIV infected children from Houston Texas

Background: HIV associated B cell exhaustion is a notable characteristic of HIV viremic adults. However, it is not known if such alterations are present in perinatal HIV infected children, whose viral dynamics differs from those seen in adults. In the present study we perform an analysis of B cells subsets and measure antigen-specific memory B cells (MBC) in a pediatric HIV infected cohort. ^ Methods: Peripheral mononuclear cells (PBMC) of perinatal HIV infected individuals are characterized into naïve (CD21hi/CD27−), classic (CD27+), tissue like (CD21lo/CD27 −) and activated MBC (CD27+CD21− ) by FACS. A memory ELISPOT assay is used to detect antibody secreting cells. We measure total IgG and antibodies specific for influenza, HBV, mumps, measles, rubella and VZV. Memory was expressed as spot forming cells (SPC) /million of PBMC. Wilcoxon rank-sum was used to compare unpaired groups and linear regression analysis was used to determine predictors of B cell dysfunction ^ Results: 41 HIV perinatal infected children are included (51.2% females and 65.9% Black). Age at study is median (range) 8.78 years (4.39-11.57). At the time of testing they have a CD4% of 30.9 (23.2-39.4), a viral load (VL) of 1.95 log10 copies/ml (1.68-3.29) and a cumulative VL of 3.4 log10 copy × days (2.7-4.0). Ninety two percent of the children are on cARV for > 6 months. Overall, HIV+ children compared with controls have a significant lower number of IgG and antigen specific SFC. In addition, they have a lower proportion of classical MBC 12.9 (8.09-19.85) vs 29.4 (18.7-39.05); 0.01, but a significant higher proportion of tissue like memory MBC 6.01 (2.79-12.7) vs 0.99 (0.87-1.38); 0.003, compared with controls. Patients are parsed on VL (<400 and ≥ 400 copies/ml) with the objective to evaluate the effect of VL on B cell status. Patients with a VL ≥ 400 copies/ml have a significantly lower IgG, HBV, measles, rubella and VZV SPC compared with those with a VL < 400 copies/ml. There are no significant differences in B cell subpopulations between the groups. A moderate negative correlation was observed between the time of cARV initiation and the frequency of IgG memory B cells, suggesting that early initiation of cARV appears to lead to a better functionality of the IgG memory B cells (P=0.05). A statistically significant positive correlation was observed between the total number of IgG memory cells and the number of antigen-specific memory B cells/SPCs. Suggesting that the progressive recovery of the IgG memory B cell pull goes along with a progressive increase in the number of antigen-specific SPCs. ^ Conclusion: A pediatric cohort in overall good status with respect to HIV infection and on ART has defects in B cell function and numbers (reduced total and antigen specific MBC and increased tissue like and reduced classical MBC).^

Chemical composition of basalts from the Atlantic Ocean

Basalt recovered beneath Jurassic sediments in the western Atlantic at Deep Sea Drilling Project sites 100 and 105 of leg 11 has petrographic features characteristic of water-quenched basalt extruded along modern ocean ridges. Site 100 basalt appears to represent two or three massive cooling units, and an extrusive emplacement is probable. Site 105 basalt is less altered and appears to be a compositionally homogeneous pillow lava sequence related to a single eruptive episode. Although the leg 11 basalts are much more closely related in time to the Triassic lavas and intrusives of eastern continental North America, their geochemical features are closely comparable to those of modern Mid-Atlantic Ridge basalts unrelated to postulated "mantle plume" activity. Projection of leg 11 sites back along accepted spreading "flow lines" to their presumed points of origin shows that these origins are also outside the influence of modern" plume" activity. Thus, these oldest Atlantic seafloor basalts provide no information on the time of initiation of these "plumes". The Triassic continental diabases show north to south compositional variations in Rb, Ba, La, and Sr which lie within the range of " plume "-related basalt on the Mid-Atlantic Ridge (20° - 40° N) This suggests that these diabases had mantle sources similar in composition to those beneath the present Mid-Atlantic Ridge. "Plumes" related to deep mantle sources may have contributed to the LIL-element enrichment in the Triassic diabase and may also have been instrumental in initiating the rifting of the North Atlantic. Systematically high values for K and Sr87/Sr86 in the Triassic diabases may reflect superimposed effects of crustal contamination in the Triassic magmas.

Benthic foraminifera in Neogene laminated diatom ooze of ODP Hole 138-844C

Several widely correlatable intervals of laminated Thalassiothrix diatom mat deposits occur in Neogene sediments recovered from the eastern equatorial Pacific Ocean. The presence of laminated sediments in extensive areas of the deep open ocean floor raises fundamental questions concerning the cause of preservation of the laminations and the nature of the benthic environment during episodes of mat deposition. Traditional explanations for the preservation of laminations have centered on restriction of dissolved oxygen. Studies of benthic foraminifers through the laminated intervals show no evidence for an increase in absolute or relative abundance of species characteristic of a low oxygen environment, but rather a decrease in relative abundance of infaunal forms attesting to the impenetrability of the diatom meshwork formed by the interlocking Thalassiothrix frustules. These results support evidence from coring of the high tensile strength of the Thalassiothrix laminations suggesting that the diatom meshwork was of sufficient tensile strength and impenetrability to suppress infaunal benthic activity. Comparison of the relative abundances of foraminifers in the enclosing ôbackgroundö sediment of foraminifer nannofossil ooze and the laminated diatom oozes shows that some epifaunal species (e.g., Cibicides spp.) increase in relative abundance within the laminated sediment, whereas others (e.g., Epistominella exigua) show a marked decrease in relative abundance. Other species show more complex changes in abundance related to the occurrence of the laminated sediments, which may indicate a combination of controls that include the physical nature of the substrate and the amount of organic flux.

Micro-granulometry of sedimentary dykes, Kathmandu basin, Nepal

Soft-sediment deformation structures have been analyzed at six sites of the Kathmandu valley. Microgranulometric study (this Supplement and Fig. 3B of Mugnier et al., Tectonophysics, 2011) reveals that silty levels (60 to 80% silt) favor the development of soft-sediment deformation structures, while sandy levels (60 to 80% sand) are passively deformed. Nonetheless well sorted sand levels (more than 80% sand) generate over-fluid pressure during compaction if located beneath a silty cap, leading to fluidization and dike development. 3-D geometry of seismites indicates a very strong horizontal shearing during their development. Using a physical approach based on soil liquefaction during horizontal acceleration, we show that the fluidization zone progressively grows down-section during the shaking, but does not exactly begin at the surface. The comparison of bed-thickness and strength/depth evolution indicates three cases: i) no soft-sediment deformation occurs for thin (few centimeters) silty beds; ii) the thickness of soft-sediment deformation above sandy beds is controlled by the lithological contrast; iii) the thickness of soft-sediment deformation depends on the shaking intensity for very thick silty beds. These 3 cases are evidenced in the Kathmandu basin. We use the 30 cm-thick soft-sediment deformation level formed during the 1833 earthquake as a reference: the 1833 earthquake rupture zone extended very close to Kathmandu, inducing there MMI IX-X damages. A 90 cm-thick sediment deformation has therefore to be induced by an event greater than MMI X. From a compilation of paleo and historic seismology studies, it is found that the great (M ~ 8.1) historical earthquakes are not characteristic of the greatest earthquakes of Himalaya; hence earthquakes greater than M ~ 8.6 occurred. Kathmandu is located above one of the asperities that laterally limits the extent of mega-earthquake ruptures and two successive catastrophic events already affected Kathmandu, in 1255 located to the west of this asperity and in ~ 1100 to the east.

Geochemistry of lavas from the Lau-Tonga arc and back-arc system

Detailed comparison of mineralogy, and major and trace geochemistry are presented for the modern Lau Basin spreading centers, the Sites 834-839 lavas, the modern Tonga-Kermadec arc volcanics, the northern Tongan boninites, and the Lau Ridge volcanics. The data clearly confirm the variations from near normal mid-ocean-ridge basalt (N-MORB) chemistries (e.g., Site 834, Central Lau Spreading Center) to strongly arc-like (e.g., Site 839, Valu Fa), the latter closely comparable to the modern arc volcanoes. Sites 835 and 836 and the East Lau Spreading Center represent transitional chemistries. Bulk compositions range from andesitic to basaltic, but lavas from Sites 834 and 836 and the Central Lau Spreading Center extend toward more silica-undersaturated compositions. The Valu Fa and modern Tonga-Kermadec arc lavas, in contrast, are dominated by basaltic andesites. The phenocryst and groundmass mineralogies show the strong arc-like affinities of the Site 839 lavas, which are also characterized by the existence of very magnesian olivines (up to Fo90-92) and Cr-rich spinels in Units 3 and 6, and highly anorthitic plagioclases in Units 2 and 9. The regional patterns of mineralogical and geochemical variations are interpreted in terms of two competing processes affecting the inferred magma sources: (1) mantle depletion processes, caused by previous melt extractions linked to backarc magmatism, and (2) enrichment in large-ion-lithophile elements, caused by a subduction contribution. A general trend of increasing depletion is inferred both eastward across the Lau Basin toward the modern arc, and northward along the Tongan (and Kermadec) Arc. Numerical modeling suggests that multistage magma extraction can explain the low abundances (relative to N-MORB) of elements such as Nb, Ta, and Ti, known to be characteristic of island arc magmas. It is further suggested that a subduction jump following prolonged slab rollback could account for the initiation of the Lau Basin opening, plausibly allowing a later influx of new mantle, as required by the recognition of a two-stage opening of the Lau Basin.

Major oxides, trace elements and rare earth elements of selected basalt samples at DSDP Hole 83-504B

DSDP Hole 504B is the deepest section drilled into oceanic basement, penetrating through a 571.5-m lava pile and a 209-m transition zone of lavas and dikes into 295 m of a sheeted dike complex. To define the basement composition 194 samples of least altered basalts, representing all lithologic units, were analyzed for their major and 26 trace elements. As is evident from the alteration-sensitive indicators H2O+, CO2, S, K, Mn, Zn, Cu, and the iron oxidation ratio, all rocks recovered are chemically altered to some extent. Downhole variation in these parameters enables us to distinguish five depth-related alteration zones that closely correlate with changes in alteration mineralogy. Alteration in the uppermost basement portion is characterized by pronounced K-uptake, sulfur loss, and iron oxidation and clearly demonstrates low-temperature seawater interaction. A very spectacular type of alteration is confined to the depth range from 910 to 1059 m below seafloor (BSF). Rocks from this basement portion exhibit the lowest iron oxidation, the highest H2O+ contents, and a considerable enrichment in Mn, S, Zn, and Cu. At the top of this zone a stockwork-like sulfide mineralization occurs. The chemical data suggest that this basement portion was at one time within a hydrothermal upflow zone. The steep gradient in alteration chemistry above this zone and the ore precipitation are interpreted as the result of mixing of the upflowing hydrothermal fluids with lower-temperature solutions circulating in the lava pile. Despite the chemical alteration the primary composition and variation of the rocks can be reliably established. All data demonstrate that the pillow lavas and the dikes are remarkably uniform and display almost the same range of variation. A general characteristic of the rocks that classify as olivine tholeiites is their high MgO contents (up to 10.5 wt.%) and their low K abundances (-200 ppm). According to their mg-values, which range from 0.60 to 0.74, most basalts appear to have undergone some high-level crystal fractionation. Despite the overall similarity in composition, there are two major basalt groups that have significantly different abundances and ratios of incompatible elements at similar mg-values. The majority of the basalts from the pillow lava and dike sections are chemically closely related, and most probably represent differentiation products of a common parental magma. They are low in Na2O, TiO2, and P2O5, and very low in the more hygromagmaphile elements. Interdigitated with this basalt group is a very rarely occurring basalt that is higher in Na2O, TiO2, P2O5, much less depleted in hygromagmaphile elements, and similar to normal mid-ocean ridge basalt (MORB). The latter is restricted to Lithologic Units 5 and 36 of the pillow lava section and Lithologic Unit 83 of the dike section. The two basalt groups cannot be related by differentiation processes but have to be regarded as products of two different parental magmas. The compositional uniformity of the majority of the basalts suggests that the magma chamber beneath the Costa Rica Rift reached nearly steady-state conditions. However, the presence of lavas and dikes that crystallized from a different parental magma requires the existence of a separate conduit-magma chamber system for these melts. Occasionally mixing between the two magma types appears to have occurred. The chemical characteristics of the two magma types imply some heterogeneity in the mantle source underlying the Costa Rica Rift. The predominant magma type represents an extremely depleted source, whereas the rare magma type presumably originated from regions of less depleted mantle material (relict or affected by metasomatism).

Temporal evolution of organic carbon and lipid content and derived SST of sediment core GIK23258-2, Norwegian Sea

Lipids are used for the evaluation of the different organic matter contributions in the north eastern Norwegian sea (M23258 site; 75ºN, 14ºE) over the last 15,000 years. Development of a mass balance model based on the down core quantification of the C37 alkenones, the odd carbon numbered n-alkanes (Aodd) and the unresolved complex mixture of hydrocarbons (UCM) has allowed three main organic matter inputs involving marine, continental and ancient reworked organic matter to be recognized. The model shows a good agreement between measured and reconstructed TOC values. Similarly, a strong parallelism is observed between predicted components such as marine TOC and carbonate content (CaCO3), which was determined independently. Representation of the model results within a time-scale based on 15 AMS-14C measurements shows that the main changes in organic matter constituents are coincident with the major climatic events of the last 15,000 a. Thus, the predominance of reworked organic matter is characteristic of Termination Ia (up to 70%), continental organic matter was dominant during the Bølling-Allerød (B-A) and Younger Dryas (YD) periods (about 85%) and a strong increase of marine organic matter occurred in the Holocene (between 50 and 75%). This agreement reflects the main hydrographic changes that determined the deposition of sedimentary materials during the period studied: ice-rafted detritus from the Barents continental platform, ice-melting waters from the Arctic fluvial system discharging into the Barents sea and dominance of north Atlantic currents, respectively. In this respect, the high-resolution down core record resulting from the mass balance and lipid measurements allows the identification of millennial-scale events such as the increase of reworked organic matter at the final retreat of the Barents ice sheet at the end of the deglaciation period (Termination Ib).

(Table 1) Basin area, average late-summer speedup, number of sinks and runoff of West Greenland Ice Sheet catchments

We use interferometric synthetic aperture radar observations recorded in a land-terminating sector of western Greenland to characterise the ice sheet surface hydrology and to quantify spatial variations in the seasonality of ice sheet flow. Our data reveal a non-uniform pattern of late-summer ice speedup that, in places, extends over 100 km inland. We show that the degree of late-summer speedup is positively correlated with modelled runoff within the 10 glacier catchments of our survey, and that the pattern of late-summer speedup follows that of water routed at the ice sheet surface. In late-summer, ice within the largest catchment flows on average 48% faster than during winter, whereas changes in smaller catchments are less pronounced. Our observations show that the routing of seasonal runoff at the ice sheet surface plays an important role in shaping the magnitude and extent of seasonal ice sheet speedup.

(Table 1) Major and trace elements of basalts at DSDP Hole 72-516F

The geochemistry of basalts recovered during Leg 72 is described with emphasis on trace elements. Only Hole 516F penetrated basement; the basalts recovered are plagioclase-phyric and olivine-phyric and pervasively altered. Chemically, the basalts from Hole 516F are rather uniform in composition. However, four distinct geochemical units can be recognized, although the chemistry of two of the units appears to be controlled by chemical mobility associated with alteration. The two less-altered units cannot be related by fractional crystallization processes. Hole 516F basalts have a trace element chemistry characteristic of T-type mid-ocean ridge basalt; rare-earth element patterns (as indicated by Ce/Y ratios) are mildly fractionated flight rare-earth element enriched), and a number of incompatible element ratios are close to chondritic.

Geochemistry and provenance of basaltic clasts within volcaniclastic debris flows at DSDP Site 89-585

Pebble-sized basaltic and glassy clasts were extracted from seamount-derived volcaniclastic debris flows and analyzed for various trace elements, including the rare earths, to determine their genetic relationships and provenance. All the clasts were originally derived from relatively shallow submarine lava flows prior to sedimentary reworking, and have undergone minor low-grade alteration. They are classified into three petrographic groups (A, B, and C) characterized by different phenocryst assemblages and variable abundances and ratios of incompatible elements. Group A (clast from Hole 585) is a hyaloclastite fragment which is olivine-normative and distinct from the other clasts, with incompatibleelement ratios characteristic of transitional or alkali basalts. Groups B and C (clasts from Hole 585A) are quartz-normative, variably plagioclase-clinopyroxene-olivine phyric tholeiites, all with essentially similar ratios of highly incompatible elements and patterns of enrichment in light rare earth elements (chrondrite-normalized). Variation within Groups B and C was governed by low-pressure fractionation of the observed phenocryst phases, whereas the most primitive compositions of each group may be related by variable partial melting of a common source. The clasts have intraplate chemical characteristics, although relative to oceanic hot-spot-related volcanics (e.g., Hawaiian tholeiites) they are marginally depleted in most incompatible elements. The source region was enriched in all incompatible elements, compared with a depleted mid-ocean-ridge basalt source.