分子生物学技术新进展

分子生物技术的发展,衍生出DNA测序、DNA突变以及基因定位和克隆的各种方法.生物芯片则是当代生物技术的最新发展,它对基础研究以及在医学上对疾病分子的探索,开拓了临床新的诊断和治疗手段.该文就这些技术和发展趋势进行综述.     

Long‐term efficacy of biologics in the treatment of psoriasis: what do we really know?

Psoriasis is a chronic inflammatory condition that often requires life-long treatment. Conventional therapies have not fully met the needs of psoriatic patients, because of limited efficacy, adverse effects with cumulative use, and patient inconvenience. In the past decade, biologic immunotherapies have become accepted treatments for psoriasis as a result of perceived efficacy and safety on the part of patients and practitioners. However, most data on these medications come from relatively limited short-term trials. In this review, we will focus on the available long-term data on the efficacy of the biologic agents. We will emphasize the strengths and weakness of the available data of the biologic agents that are Food and Drug Administration (FDA)-approved for the treatment of moderate to severe psoriasis (alefacept, efalizumab, * etanercept, infliximab, and adalimumab), with the inclusion of a newer agent currently under FDA evaluation (ustekinumab).     

Pseudotumor associated with polytetrafluoroethylene sleeves

We report the case of a patient who was operated on in February 2001. We performed a wedge resection of the upper right lobe. The pathologic examination demonstrated a lung adenocarcinoma (pT2N0M0, R0). We used staple line reinforcement material (ePTFE) during the operation because the patient had an important emphysema. We re-operated in January 2005 because during follow-up we observed a suspicious image that suggested a tumoral relapse. Histopathological study showed extrinsic material compatible with the one used in the original resection.     

不同转移特性瘤细胞系的筛选及其生物学特性

目的：探讨与肿瘤转移相关的某些生物学特性。方法：将小鼠乳腺癌Ｃａ７６１－ＦＰ８／Ｌ和Ｃａ７６１－ＦＬ１０／Ｌ经体内筛选得到细胞系Ｃａ７６１－Ｐ５Ｂ和Ｃａ７６１＝Ｌ６Ｂ，并观察其瘤细胞与凝集反应、靶器官组织条件培养基对瘤细胞真挚化作用等，结果：Ｃａ７６１－Ｐ５Ｂ具有高肺转移、低淋巴结转移特性，Ｃａ７６１－Ｌ５Ｂ具有低肺、低淋巴结转移特性。两个瘤细胞系的细胞表面的糖基表达，对条件培养的趋化反应不同。结     

生物分析法测定人血浆D-聚甘酯

目的:建立测定人血浆中D-聚甘酯的生物分析法。方法:应用 aPTT试剂盒,采用免疫荧光比浊法在 ACL futura plus全自动血凝仪上进行自动定量分析,aPTT来检测血浆中D-聚甘酯浓度,考察其线性范围、精密度及回收率等。结果:D-聚甘酯在0.05～10.0 mg·L~(-1)血浆浓度范围内线性关系良好(r=0.9957,n=10),最低检测浓度为 0.05 mg·L~(-1)。1.0,5.0,10.0 mg·L~(-1)3个浓度的回收率分别为 91.48％,97.56％,105.67％,RSD均小于 14％。这 3个浓度日内及日间 RSD(n=5)分别为 10.63％,5.73％,1.58％和12.91％,9.42％,7.19％。结论:建立的D-聚甘酯生物测定方法操作简便,结果灵敏、准确、可靠,可进一步用于该药的药代动力学研究。     

Therapeutic drug monitoring with biologic agents in immune mediated inflammatory diseases

ABSTRACT

Introduction: Biologic therapy has revolutionized the treatment of immune mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), rheumatoid and psoriatic arthritis, ankylosing spondylitis and psoriasis. Nevertheless, some patients exhibit primary nonresponse (PNR) or secondary loss of response (SLR) to biologics.

Areas covered: This collaborative review provides data on the role of therapeutic drug monitoring (TDM) in IMID for optimizing biologic therapy including infliximab, adalimumab, certolizumab pegol etanercept and golimumab vedolizumab, secukinumab and ustekinumab.

Expert opinion: Most exposure-response relationship studies show a positive correlation between biologic drug concentrations and favorable therapeutic outcomes in IMID with higher drug concentrations typically associated with more objective outcomes. Clinically, reactive TDM rationalizes the management of PNR and SLR to anti-tumor necrosis factor therapy and is emerging as the new standard of care in IBD as it is also more cost-effective than empiric dose escalation. Preliminary data suggest that proactive TDM with the goal to achieve a threshold drug concentration is associated with better therapeutic outcomes when compared to empiric drug optimization and/or reactive TDM of infliximab and adalimumab in IBD. However, more data from well-designed prospective studies are needed to prove the benefit of TDM-based algorithms in real life clinical practice in IMID.     

Current Concepts in Rheumatology,Royal Society of Medicine

Ustekinumab is a fully human monoclonal antibody directed against the p40 subunit shared by interleukin 12 and interleukin 23, two naturally occurring protein regulators that play an important role in immune-mediated inflammatory diseases, including psoriatic arthritis (PsA). In September of 2009, the US FDA approved ustekinumab for the treatment of adult patients with moderate to severe plaque psoriasis. Beginning in November of 2009, Janssen Biotech (formerly Centocor Biotech), the developer of ustekinumab, initiated clinical trials to investigate the efficacy of ustekinumab in the treatment of other inflammatory disorders, including PsA. Phase II and Phase III studies showed both a good safety profile and significant efficacy for ustekinumab in the treatment of PsA, leading to the drug's approval in both Europe and the USA. In an immunotherapy market currently dominated by anti-TNF-α drugs for the treatment of PsA, ustekinumab offers an alternative option for patients with PsA, including those unresponsive to methotrexate and the TNF-α inhibitory agents currently approved for this potentially debilitating disease.