Ribavirin-Induced Anemia in Hepatitis C Virus Patients Undergoing Combination Therapy

The current standard of care for hepatitis C virus (HCV) infection - combination therapy with pegylated interferon and ribavirin - elicits sustained responses in only similar to 50% of the patients treated. No alternatives exist for patients who do not respond to combination therapy. Addition of ribavirin substantially improves response rates to interferon and lowers relapse rates following the cessation of therapy, suggesting that increasing ribavirin exposure may further improve treatment response. A key limitation, however, is the toxic side-effect of ribavirin, hemolytic anemia, which often necessitates a reduction of ribavirin dosage and compromises treatment response. Maximizing treatment response thus requires striking a balance between the antiviral and hemolytic activities of ribavirin. Current models of viral kinetics describe the enhancement of treatment response due to ribavirin. Ribavirin-induced anemia, however, remains poorly understood and precludes rational optimization of combination therapy. Here, we develop a new mathematical model of the population dynamics of erythrocytes that quantitatively describes ribavirin-induced anemia in HCV patients. Based on the assumption that ribavirin accumulation decreases erythrocyte lifespan in a dose-dependent manner, model predictions capture several independent experimental observations of the accumulation of ribavirin in erythrocytes and the resulting decline of hemoglobin in HCV patients undergoing combination therapy, estimate the reduced erythrocyte lifespan during therapy, and describe inter-patient variations in the severity of ribavirin-induced anemia. Further, model predictions estimate the threshold ribavirin exposure beyond which anemia becomes intolerable and suggest guidelines for the usage of growth hormones, such as erythropoietin, that stimulate erythrocyte production and avert the reduction of ribavirin dosage, thereby improving treatment response. Our model thus facilitates, in conjunction with models of viral kinetics, the rational identification of treatment protocols that maximize treatment response while curtailing side effects.

Reduction of quinolines to 1,2,3,4-tetrahydro derivatives employing a combination of NaCNBH3 and BF3.OEt(2)

A regiospecific reduction of quinolines (and 1,10-phenanthroline) into the corresponding 1,2,3,4-tetrahydro derivatives using a combination of sodium cyanoborohydride and boron trifluoride etherate in refluxing methanol is described. Under the same conditions indole and acridine reduced to the corresponding dihydroderivatives, whereas acyl group transfer from oxygen to nitrogen atom is also noticed in the case of 8-acyloxyquinolines.

The Boltzmann collision integrals for a combination of Maxwellians

The gain and loss integrals in the Boltzmann equation for a rigid sphere gas are evaluated in closed form for a distribution which can be expressed as a linear combination of Maxwellians. Application to the Mott-Smith bimodal distribution shows that the gain is also bimodal, but the two modes in the gain are less pronounced than in the distribution. Implications of these results for simple collision models in non-equilibrium flow are discussed.

Authors reply to "On uniqueness, transfer and combination of acoustic sources in one-dimensional systems"

The use of electroacoustic analogies suggests that a source of acoustical energy (such as an engine, compressor, blower, turbine, loudspeaker, etc.) can be characterized by an acoustic source pressure ps and internal source impedance Zs, analogous to the open-circuit voltage and internal impedance of an electrical source. The present paper shows analytically that the source characteristics evaluated by means of the indirect methods are independent of the loads selected; that is, the evaluated values of ps and Zs are unique, and that the results of the different methods (including the direct method) are identical. In addition, general relations have been derived here for the transfer of source characteristics from one station to another station across one or more acoustical elements, and also for combining several sources into a single equivalent source. Finally, all the conclusions are extended to the case of a uniformly moving medium, incorporating the convective as well as dissipative effects of the mean flow.

Curcumin-Arteether Combination Therapy of Plasmodium berghei-Infected Mice Prevents Recrudescence Through Immunomodulation

Earlier studies in this laboratory have shown the potential of artemisinin-curcumin combination therapy in experimental malaria. In a parasite recrudescence model in mice infected with Plasmodium berghei (ANKA), a single dose of alpha, beta-arteether (ART) with three oral doses of curcumin prevented recrudescence, providing almost 95% protection. The parasites were completely cleared in blood with ART-alone (AE) or ART+curcumin (AC) treatments in the short-term, although the clearance was faster in the latter case involving increased ROS generation. But, parasites in liver and spleen were not cleared in AE or AC treatments, perhaps, serving as a reservoir for recrudescence. Parasitemia in blood reached up to 60% in AE-treated mice during the recrudescence phase, leading to death of animals. A transient increase of up to 2-3% parasitemia was observed in AC-treatment, leading to protection and reversal of splenomegaly. A striking increase in spleen mRNA levels for TLR2, IL-10 and IgG-subclass antibodies but a decrease in those for INF gamma and IL-12 was observed in AC-treatment. There was a striking increase in IL-10 and IgG subclass antibody levels but a decrease in INF gamma levels in sera leading to protection against recrudescence. AC-treatment failed to protect against recrudescence in TLR2(-/-) and IL-10(-/-) animals. IL-10 injection to AE-treated wild type mice and AC-treated TLR22/2 mice was able to prolong survival. Blood from the recrudescence phase in AE-treatment, but not from AC-treatment, was able to reinfect and kill naive animals. Sera from the recrudescence phase of AC-treated animals reacted with several parasite proteins compared to that from AE-treated animals. It is proposed that activation of TLR2-mediated innate immune response leading to enhanced IL-10 production and generation of anti-parasite antibodies contribute to protective immunity in AC-treated mice. These results indicate a potential for curcumin-based combination therapy to be tested for prevention of recrudescence in falciparum and relapse in vivax malaria.

Artemisinin-based combination with curcumin adds a new dimension to malaria therapy

Malaria afflicts 300 million people worldwide, with over a million deaths every year. With no immediate prospect of a vaccine against the disease, drugs are the only choice to treat it. Unfortunately, the parasite has become resistant to most antimalarials, restricting the option to use artemisinins (ARTs) for effective cure. With the use of ARTs as the front-line antimalarials, reports are already available on the possible resistance development to these drugs as well. Therefore, it has become necessary to use ART-based combination therapies to delay emergence of resistance. It is also necessary to discover new pharmacophores to eventually replace ART. Studies in our laboratory have shown that curcumin not only synergizes with ART as an antimalarial to kill the parasite, but is also uniquely able to prime the immune system to protect against parasite recrudescence in the animal model. The results indicate a potential for the use of ART curcumin combination against recrudescence/relapse in falciparum and vivax malaria. In addition, studies have also suggested the use of curcumin as an adjunct therapy against cerebral malaria. In this review we have attempted to highlight these aspects as well as the studies directed to discover new pharmacophores as potential replacements for ART.

Structure and mechanical properties of Ti-C films deposited using combination of pulsed DC and normal DC magnetron co-sputtering

Titanium-carbon (Ti-C) thin films of different compositions were prepared by a combination of pulsed DC (for Ti target) and normal DC (for graphite target) magnetron co-sputtering on oxidized silicon and fused quartz substrates. At 33.7 at.% of C content, pure hcp Ti transforms into fcc-TiC with a preferential orientation of (2 2 0) along with (1 1 1) and (2 0 0). A clear transformation in the preferential orientation from (2 2 0) to (1 1 1) has been observed when the C content was increased to 56 at.%. At 62.5 at.% of C, TiC precipitates in an amorphous carbon matrix whereas further increase in C leads to X-ray amorphous films. The cross-sectional scanning electron microscope images reveal that the films with low carbon content consists of columnar grains, whereas, randomly oriented grains are in an amorphous carbon matrix at higher carbon content. A dramatic variation was observed in the mechanical properties such as hardness, H, from 30 to 1 GPa and in modulus, E, from 255 to 25 GPa with varying carbon content in the films. Resistance to plastic deformation parameter was observed as 0.417 for films containing 62.5 at.% of C. Nanoscratch test reveals that the films are highly scratch resistant with a coefficient of friction ranging from 0.15 to 0.04. (C) 2012 Elsevier B.V. All rights reserved.

Silicon surface texturing with a combination of potassium hydroxide and tetra-methyl ammonium hydroxide etching

A two step silicon surface texturing, consisting of potassium hydroxide (KOH) etching followed by tetra-methyl ammonium hydroxide etching is presented. This combined texturing results in 13.8% reflectivity at 600 nm compared to 16.1% reflectivity for KOH etching due to the modification of microstructure of etched pyramids. This combined etching also results in significantly lower flat-band voltage (V-FB) (-0.19V compared to -1.3 V) and interface trap density (D-it) (2.13 x 10(12) cm(-2) eV(-1) compared to 3.2 x 10(12) cm(-2) eV(-1)). (C) 2013 American Institute of Physics. http://dx.doi.org/10.1063/1.4776733]

Combination of similarity measures for time series classification using genetic algorithms

Time series classification deals with the problem of classification of data that is multivariate in nature. This means that one or more of the attributes is in the form of a sequence. The notion of similarity or distance, used in time series data, is significant and affects the accuracy, time, and space complexity of the classification algorithm. There exist numerous similarity measures for time series data, but each of them has its own disadvantages. Instead of relying upon a single similarity measure, our aim is to find the near optimal solution to the classification problem by combining different similarity measures. In this work, we use genetic algorithms to combine the similarity measures so as to get the best performance. The weightage given to different similarity measures evolves over a number of generations so as to get the best combination. We test our approach on a number of benchmark time series datasets and present promising results.

Combination of single walled carbon nanotubes/graphene oxide with paclitaxel: a reactive oxygen species mediated synergism for treatment of lung cancer

Heterogeneity in tumors has led to the development of combination therapies that enable enhanced cell death. Previously explored combination therapies mostly involved the use of bioactive molecules. In this work, we explored a non-conventional strategy of using carbon nanostructures (CNs) single walled carbon nanotube (SWNT) and graphene oxide (GO)] for potentiating the efficacy of a bioactive molecule paclitaxel (Tx)] for the treatment of lung cancer. The results demonstrated enhanced cell death following combination treatment of SWNT/GO and Tx indicating a synergistic effect. In addition, synergism was abrogated in the presence of an anti-oxidant, N-acetyl cysteine (NAC), and was therefore shown to be reactive oxygen species (ROS) dependent. It was further demonstrated using bromodeoxyuridine (BrdU) incorporation assay that treatment with CNs was associated with enhanced mitogen associated protein kinase (MAPK) activation that was ROS mediated. Hence, these results for the first time demonstrated the potential of SWNT/GO as co-therapeutic agents with Tx for the treatment of lung cancer.

Improved modeling of groundwater recharge in agricultural watersheds using a combination of crop model and remote sensing

For improved water management and efficiency of use in agriculture, studies dealing with coupled crop-surface water-groundwater models are needed. Such integrated models of crop and hydrology can provide accurate quantification of spatio-temporal variations of water balance parameters such as soil moisture store, evapotranspiration and recharge in a catchment. Performance of a coupled crop-hydrology model would depend on the availability of a calibrated crop model for various irrigated/rainfed crops and also on an accurate knowledge of soil hydraulic parameters in the catchment at relevant scale. Moreover, such a coupled model should be designed so as to enable the use/assimilation of recent satellite remote sensing products (optical and microwave) in order to model the processes at catchment scales. In this study we present a framework to couple a crop model with a groundwater model for applications to irrigated groundwater agricultural systems. We discuss the calibration of the STICS crop model and present a methodology to estimate the soil hydraulic parameters by inversion of crop model using both ground and satellite based data. Using this methodology we demonstrate the feasibility of estimation of potential recharge due to spatially varying soil/crop matrix.

Pre-clinical toxicity & immunobiological evaluation of DNA rabies vaccine & combination rabies vaccine in rhesus monkeys (Macaca mulatta)

Background & objectives: Pre-clinical toxicology evaluation of biotechnology products is a challenge to the toxicologist. The present investigation is an attempt to evaluate the safety profile of the first indigenously developed recombinant DNA anti-rabies vaccine DRV (100 mu g)] and combination rabies vaccine CRV (100 mu g DRV and 1.25 IU of cell culture-derived inactivated rabies virus vaccine)], which are intended for clinical use by intramuscular route in Rhesus monkeys. Methods: As per the regulatory requirements, the study was designed for acute (single dose - 14 days), sub-chronic (repeat dose - 28 days) and chronic (intended clinical dose - 120 days) toxicity tests using three dose levels, viz. therapeutic, average (2x therapeutic dose) and highest dose (10 x therapeutic dose) exposure in monkeys. The selection of the model i.e. monkey was based on affinity and rapid higher antibody response during the efficacy studies. An attempt was made to evaluate all parameters which included physical, physiological, clinical, haematological and histopathological profiles of all target organs, as well as Tiers I, II, III immunotoxicity parameters. Results: In acute toxicity there was no mortality in spite of exposing the monkeys to 10XDRV. In sub chronic and chronic toxicity studies there were no abnormalities in physical, physiological, neurological, clinical parameters, after administration of test compound in intended and 10 times of clinical dosage schedule of DRV and CRV under the experimental conditions. Clinical chemistry, haematology, organ weights and histopathology studies were essentially unremarkable except the presence of residual DNA in femtogram level at site of injection in animal which received 10X DRV in chronic toxicity study. No Observational Adverse Effects Level (NOAEL) of DRV is 1000 ug/dose (10 times of therapeutic dose) if administered on 0, 4, 7, 14, 28th day. Interpretation & conclusions: The information generated by this study not only draws attention to the need for national and international regulatory agencies in formulating guidelines for pre-clinical safety evaluation of biotech products but also facilitates the development of biopharmaceuticals as safe potential therapeutic agents.