SciCombinator

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Concept: Infusion

179

Patients with primary immunodeficiency disease (PIDD) typically require life-long intravenous (IV) or subcutaneous (SC) immunoglobulin (Ig) replacement therapy to prevent recurrent infections. The efficacy, safety, and pharmacokinetics of a highly concentrated (20 %) Ig preparation for SC administration (IGSC 20 %) were evaluated in a prospective trial in patients with PIDD. A total of 74 patients (aged 3-83 years) received 4327 IGSC 20 % infusions over a median of 380.5 days. The rate of validated serious bacterial infections was 0.012 event/patient-year (p < 0.0001 compared with the historical control), and the annualized rate of infection was 2.41 events/patient. Median IgG trough levels were >14.5 g/l. The median maximum infusion rate was 60 ml/h/site (range 4.4-180), resulting in a median infusion duration of 0.95 h. A volume ≥30 ml was infused per site in 74.8 % of IGSC 20 % infusions. Most (84.9 %) infusions were administered using ≤2 infusion sites; for 99.8 % of infusions, there was no need to interrupt/stop administration or reduce the infusion rate. No related serious adverse event (AE) occurred during IGSC 20 % treatment; related non-serious AEs occurred at a rate of 0.036 event/infusion. The incidence of related local AEs was 0.015 event/infusion and of related systemic AEs was 0.021 event/infusion; most were mild in severity, none severe. Increased infusion rates or volumes were not associated with higher AE rates. The investigated IGSC 20 % treatment was shown to be effective and safe, enabling higher infusion rates and volumes per site compared to conventional SC treatments, resulting in fewer infusion sites and shorter infusion durations.

Concepts: Infusion pump, Infectious disease, Infusion, Infection, Bacteria, Immunodeficiency, Primary immunodeficiency, Immune system

123

Murine models showed that CD8+CD44himemory T ™ cells could eradicate malignant cells without inducing graft-versus-host disease (GVHD). We evaluated the feasibility and safety of infusing freshly isolated and purified donor-derived phenotypic CD8+TMcells into adults with disease relapse after allogeneic hematopoietic cell transplantation (HCT). Phenotypic CD8 TMcells were isolated after unmobilized donor apheresis using a tandem immunomagnetic selection strategy of CD45RA depletion followed by CD8+enrichment. Fifteen patients received CD8+TMcells at escalating doses (1 × 106, 5 × 106, or 10 × 106cells per kg). Thirteen received cytoreduction before CD8+TMcell infusion, and 9 had active disease at the time of infusion. Mean yield and purity of the CD8+TMinfusion were 38.1% and 92.8%, respectively; >90% had CD8+T effector memory phenotype, cytokine expression, and secretion profile. No adverse infusional events or dose-limiting toxicities occurred; GVHD developed in 1 patient (grade 2 liver). Ten patients (67%) maintained or achieved response (7 complete response, 1 partial response, 2 stable disease) for at least 3 months after infusion; 4 of the responders had active disease at the time of infusion. With a median follow-up from infusion of 328 days (range, 118-1328 days), median event-free survival and overall survival were 4.9 months (95% confidence interval [CI], 1-19.3 months) and 19.6 months (95% CI, 5.6 months to not reached), respectively. Collection and enrichment of phenotypic CD8+TMcells is feasible, well tolerated, and associated with a low incidence of GVHD when administered as a manipulated infusion of donor lymphocytes in patients who have relapsed after HCT. This trial was registered at www.clinicaltrials.gov as #NCT01523223.

Concepts: Normal distribution, Thymus, Medical terms, Infusion, Graft-versus-host disease, Cancer, Gene, Hematopoietic stem cell transplantation

28

BACKGROUND: Animal studies have shown that two repeated intramuscular injections of acidic saline induce mechanical allodynia that lasts for 4 weeks with spread to the contralateral side. In this study, we tested the hypothesis that two repeated intramuscular infusions of acidic saline into the human masseter muscle is associated with pain, mechanical allodynia and release of algesic substances. Eighteen healthy volunteers participated. On day 1, 2.5 mL of acidic saline (pH 3.3) was infused into one of the masseter muscles and isotonic saline (pH 6.0) into the other (randomized and single-blind). Two days later, intramuscular microdialysis was performed to sample serotonin, glutamate, pyruvate, lactate and glucose, during which the saline infusions were repeated. Pain and pressure pain thresholds (PPTs) were recorded before and after infusions on both days. RESULTS: Pain intensity induced by the infusions was higher after acidic than that after isotonic saline (p < 0.05). PPTs were decreased on both sides after microdialysis compared with baseline day 1 (p's < 0.05), but there were no differences in PPTs between sides at any time point. The levels of serotonin, glutamate, pyruvate, lactate or glucose did not change significantly during microdialysis. CONCLUSION: Infusion of acidic saline caused low levels of muscle pain, but no mechanical allodynia and no increased release of algesic substances. The value of this model appears modest, but future studies could be performed with larger sample size and higher flow rate before definite conclusions about the validity of the model for craniofacial myalgia can be drawn.

Concepts: Peripheral neuropathy, Hypokalemia, Sample size, Lactic acid, Masseter muscle, Infusion, Myalgia, Muscle

26

To examine the cardiopulmonary effects of infusions of remifentanil or morphine, and their influence on recovery of horses anesthetized with isoflurane and dexmedetomidine.

Concepts: Infusion pump, Infusion, Opioid

11

Adoptive immunotherapy for solid tumors relies on infusing large numbers of T cells to mediate successful antitumor responses in patients. While long-term rapid-expansion protocols (REPs) produce sufficient numbers of CD8(+) T cells for treatment, they also cause decline in the cell’s therapeutic fitness. In contrast, we discovered that IL-17-producing CD4(+) T cells (Th17 cells) do not require REPs to expand 5,000-fold over 3 weeks. Also, unlike Th1 cells, Th17 cells do not exhibit hallmarks of senescence or apoptosis, retaining robust antitumor efficacy in vivo. Three-week-expanded Th17 cells eliminated melanoma as effectively as Th17 cells expanded for 1 week when infused in equal numbers into mice. However, treating mice with large recalcitrant tumors required the infusion of all cells generated after 2 or 3 weeks of expansion, while the cell yield obtained after 1-week expansion was insufficient. Long-term-expanded Th17 cells also protected mice from tumor rechallenge including lung metastasis. Importantly, 2-week-expanded human chimeric antigen receptor-positive (CAR(+)) Th17 cells also retained their ability to regress human mesothelioma, while CAR(+) Th1 cells did not. Our results indicate that tumor-reactive Th17 cells are an effective cell therapy for cancer, remaining uncompromised when expanded for a long duration owing to their resistance to senescence.

Concepts: In vivo, Neoplasm, Infusion, Tumor, Immune system, Metastasis, Oncology, Cancer

5

A new family of polymeric, lubricant-infused, nanostructured wrinkled surfaces was designed that effectively retains inert non-toxic silicone oil, upon draining by spin-coating and vigorous shear for two weeks. The wrinkled surfaces were fabricated using three different polymers (Teflon AF, polystyrene, and poly(4-vinylpyridine)) and two shrinkable substrates (polyshrink and shrinkwrap), and Teflon on polyshrink was found to be the most effective system. The volume of trapped lubricant was quantified by adding Nile red to the silicone oil before infusion, then extracting the oil and Nile red from the surfaces in heptane and measuring by fluorimetry. Higher volumes of lubricant induced lower roll-off angles for water droplets, and in turn induced better antifouling performance. The infused surfaces displayed stability in seawater and inhibited growth of Pseudoalteromonas spp. bacteria up to 99%, with as little as 0.9 μL cm-2 of silicone oil infused. Field tests in the waters of Sydney Harbour over seven weeks showed that silicone oil infusion inhibited the attachment of algae, but as the silicone oil was slowly depleted over time algal attachment increased. The infused wrinkled surfaces have high transparency and are moldable, making them suited to protecting the windows of underwater sensors and cameras.

Concepts: Liquid, Tincture, Polydimethylsiloxane, Silicone, Infusion, Lubricant, Polymer, Water

4

How might religion shape intergroup conflict? We tested whether religious infusion-the extent to which religious rituals and discourse permeate the everyday activities of groups and their members-moderated the effects of two factors known to increase intergroup conflict: competition for limited resources and incompatibility of values held by potentially conflicting groups. We used data from the Global Group Relations Project to investigate 194 groups (e.g., ethnic, religious, national) at 97 sites around the world. When religion was infused in group life, groups were especially prejudiced against those groups that held incompatible values, and they were likely to discriminate against such groups. Moreover, whereas disadvantaged groups with low levels of religious infusion typically avoided directing aggression against their resource-rich and powerful counterparts, disadvantaged groups with high levels of religious infusion directed significant aggression against them-despite the significant tangible costs to the disadvantaged groups potentially posed by enacting such aggression. This research suggests mechanisms through which religion may increase intergroup conflict and introduces an innovative method for performing nuanced, cross-societal research.

Concepts: Infusion, Religion, Morality, Ritual

4

Objective. Complex regional pain syndrome type I (CRPS-I) is a severely disabling pain syndrome for which no definite treatment has been established. The aim of this multi-centre, randomized, double-blind placebo-controlled trial was to test the efficacy of the amino-bisphosphonate neridronate in patients with CRP-I.Methods. Eighty-two patients with CRP-I at either hand or foot were randomly assigned to i.v. infusion of 100 mg neridronate given four times over 10 days or placebo. After 50 days the former placebo patients were given open label the same regimen of neridronate.Results. Within the first 20 days, visual analogue scale (VAS) score decreased significantly more in the neridronate group. In the following 20 days, VAS remained unchanged in the placebo group and further decreased in the active group by 46.5 mm (95% CI -52.5, -40.5) vs 22.6 mm (95% CI -28.8, -16.3) for placebo group (P < 0.0001). Significant improvements vs placebo were observed also for a number of other indices of pain and quality of life. During the open-extension phase in the formerly placebo group the results of treatment were superimposable on those seen during the blind phase in the active group. A year later none of the patients was referring symptoms linked to CRPS-I.Conclusion. In patients with acute CRPS-I, four i.v. infusions of neridronate 100 mg are associated with clinically relevant and persistent benefits. These results provide conclusive evidence that the use of bisphosphonates, at appropriate doses, is the treatment of choice for CRPS-I.Trial registration: EU Clinical Trials Register, https://www.clinicaltrialsregister.eu/, 2007-003372-18.

Concepts: Pain, Infusion, The Blind, Complexity, Randomness, Clinical trial, Complex regional pain syndrome, Placebo

3

Alzheimer’s disease (AD) is characterized by the deposition of β-amyloid (Aβ) senile plaques and tau-associated neurofibrillary tangles. Other disease features include neuroinflammation and cholinergic neurodegeneration, indicating their possible importance in disease propagation. Recent studies have shown that monocytic cells can migrate into the AD brain toward Aβ plaques and reduce plaque burden. The purpose of this study was to evaluate whether the administration of intravenous infusions of ‘young’ CD11b-positive (+) monocytes into an AD mouse model can enhance Aβ plaque clearance and attenuate cognitive deficits. Peripheral monocytes were isolated from two-week-old wildtype mice using the Pluriselect CD11b+ isolation method and characterized by FACS analysis for surface marker expression and effective phagocytosis of 1 μm fluorescent microspheres, FITC-Dextran or FITC-Aβ1-42. The isolated monocytes were infused via the tail vein into a transgenic AD mouse model, which expresses the Swedish, Dutch/Iowa APP mutations (APPSwDI). The infusions began when animals reached 5 months of age, when little plaque deposition is apparent and were repeated again at 6 and 7 months of age. At 8 months of age, brains were analyzed for Aβ+ plaques, inflammatory processes and microglial (Iba1) activation. Our data show that infusions of two-week-old CD11b+ monocytes into adult APPSwDI mice results in a transient improvement of memory function, a reduction (30%) in Aβ plaque load and significantly in small (<20 μm) and large (>40 μm) plaques. In addition, we observe a reduction in Iba1+ cells, as well as no marked elevations in cytokine levels or other indicators of inflammation. Taken together, our findings indicate that young CD11b+ monocytes may serve as therapeutic candidates for improved Aβ clearance in AD.

Concepts: Gene, Dementia, Memory, Infusion, Neurofibrillary tangle, Neurology, Inflammation, Alzheimer's disease

2

Children with chronic rheumatic disease often require intravenous (IV) therapy. Our center has instituted standardized protocols for use of IV medications in rheumatology patients. Herein, we introduce the therapeutic protocols and report on their short-term safety.

Concepts: Injection, Infusion, Therapy, Specialty, Cure, Rheumatism, Rheumatology, Medicine