A phase I study of dexosome immunotherapy in patients with advanced non-small cell lung cancer

BACKGROUND: There is a continued need to develop more effective cancer immunotherapy strategies. Exosomes, cell-derived lipid vesicles that express high levels of a narrow spectrum of cell proteins represent a novel platform for delivering high levels of antigen in conjunction with costimulatory molecules. We performed this study to test the safety, feasibility and efficacy of autologous dendritic cell (DC)-derived exosomes (DEX) loaded with the MAGE tumor antigens in patients with non-small cell lung cancer (NSCLC). METHODS: This Phase I study enrolled HLA A2+ patients with pre-treated Stage IIIb (N = 4) and IV (N = 9) NSCLC with tumor expression of MAGE-A3 or A4. Patients underwent leukapheresis to generate DC from which DEX were produced and loaded with MAGE-A3, -A4, -A10, and MAGE-3DPO4 peptides. Patients received 4 doses of DEX at weekly intervals. RESULTS: Thirteen patients were enrolled and 9 completed therapy. Three formulations of DEX were evaluated; all were well tolerated with only grade 1-2 adverse events related to the use of DEX (injection site reactions (N = 8), flu like illness (N = 1), and peripheral arm pain (N = 1)). The time from the first dose of DEX until disease progression was 30 to 429+ days. Three patients had disease progression before the first DEX dose. Survival of patients after the first DEX dose was 52-665+ days. DTH reactivity against MAGE peptides was detected in 3/9 patients. Immune responses were detected in patients as follows: MAGE-specific T cell responses in 1/3, increased NK lytic activity in 2/4. CONCLUSION: Production of the DEX vaccine was feasible and DEX therapy was well tolerated in patients with advanced NSCLC. Some patients experienced long term stability of disease and activation of immune effectors.     

Predictive value of normal sperm morphology: a structured literature review

The aim of the study was to conduct a structured review of theliterature published on the use of normal sperm morphology,as an indicator of male fertility potential in the in-vitrofertilization (IVF) situation, and to establish the universalpredictive value of this semen parameter. Published literaturein which normal sperm morphology was used to predict fertilizationand pregnancy, during the period 1978-1996, was reviewed. Atotal of 216 articles were identified by the sourcing methodology,but only 49 provided data that could be tabulated and analysed.Of these, only 18 provided sufficient data for statistical analysis.Fifteen studies used the strict criteria to evaluate sperm morphology,two used World Health Organization (WHO) guidelines and oneused both the strict criteria and the WHO guidelines. All thestudies (n=10) using the 5 and 14% normal sperm morphology thresholds(strict criteria) produced positive predictive values for IVFsuccess. In the prediction of pregnancy, 82% (9/11) and 75%(6/8) of the studies produced positive predictive values whenusing the 5% and 14% thresholds respectively. Aggregating thedata produced around the 5% normal sperm morphology threshold(strict criteria), the overall fertilization rates were 59.3%(1979/3337; per oocyte) for the 4% group and 77.6% (10345/13327;per oocyte) for the >4% group, and the overall pregnancyrates were 15.2% (60/395; per cycle) and 26.0% (355/1368; percycle) respectively. The no-transfer rates across the 5% thresholdwere 24.0% (86/359; per cycle) in the 4% group compared to 7.4%(80/1088; per cycle) in the >4% group. The inclusion of anaccurately evaluated normal sperm morphology count as an integralpart of the standard semen analysis makes this analysis stillthe most cost-effective means of evaluating the male factor.     

Persistent pulmonary infection with an azole-resistant Coccidioides species.

We report a case of a life-threatening, recurrent, and azole-resistant pulmonary coccidioidomycosis in a patient receiving long-term fluconazole therapy for a history of coccidioidal meningitis. Since this diagnosis, the patient has received weekly amphotericin B for more than four years and remains in remission with a stable serum Coccidioides complement fixation antibody titer.     

Instant Cirrhosis: An Improved Method for Producing Cirrhosis of the Liver in Rats by Simultaneous Administration of Carbon Tetrachloride and Phenobarbitone

An improved method for production of cirrhosis of the liver in rats is described. Rats are given CCl₄ and phenobarbitone simultaneously. The method doubles the yield of cirrhotic animals and halves the time taken for their production, in comparison with CCl₄ alone.CCl₄ inhalation results in fewer intercurrent deaths than oral dosing of CCl₄. The cirrhosis as observed histologically is accompanied by gross nodularity of the liver, splenomegaly, portal hypertension and testicular atrophy. About 50 per cent of animals have measurable ascites. Animals killed during application of the new method show that cirrhosis develops only after 4 weeks of CCl₄ dosage.     

Evoked Potentials in Hyperkinetic and Normal Children Under Certainty and Uncertainty: A Placebo and Methylphenidate Study

Differences between hyperkinetic children and normal children and the effects of methylphenidate on hyperkinetic children were investigated under conditions of differential attentional demands. Auditory average evoked potentials were recorded from vertex using a single/double click guessing paradigm under conditions of certainty and uncertainty. Under conditions of certainty (low attention), in which the subject was told the identity of each stimulus in advance, few significant group differences were found. Under conditions of uncertainty (high attention), in which the subject was asked to guess which stimulus would be presented, large group differences were found. In response to the second click the P200 component was found to be smaller and the N250 component was larger in hyperkinetic children than in normal children. Treatment with methylphenidate “normalized” the evoked potentials of the hyperkinetic children making them more like those of normal children. The findings are believed: 1) to reflect the deficit in attention observed behaviorally in hyperkinetic children, 2) to support a model of hypoarousal in hyperkinetic children, and 3) to reflect the behavioral “normalization” observed in hyperkinetic children treated with melhylphenidate.