Rapid Increase In Serum Concentration Research Articles

Establishment of an In Vivo Mouse Model to Study and Overcome Infusion Related Reactions Associated with Fcgriib Antibody Administration

Introduction Administration of therapeutic monoclonal antibodies (mAb) is often accompanied by infusion related reactions (IRR), of ill-determined mechanism. During the clinical development of BI-1206 (NCT02933320 and NCT03571568), a fully human mAb that binds specifically to hFcγRIIB (hCD32B), frequent IRR were observed, independent of sustained FcγRIIB blockade. At 100mg/patient, BI-1206 showed transient receptor saturation for up to 72h, whereas IRR most often resolved within 24h. Administration of BI-1206 was aslo associated with transient thrombocytopenia but not increased bleeding, and most episodes resolved within a week. Elevated transaminases (i.e. alanine transaminase (ALT) and aspartate transaminase (AST)) and a transient cytokine release was also observed alongside thrombocytopenia. Methods Six to eight-week-old C57BL/6 mice were injected either through intravenous (i.v.), intra-peritoneal (i.p.) or subcutaneous (s.c.) routes with a surrogate mouse anti-FcγRIIB (AT130-2 IgG2a) in doses ranging from 1-400μg/mouse. Mice were monitored post injection for changes in behavior and macroscopic symptoms such as isolation, mobility, and fur condition. Serum concentration of AT130-2 were quantified using an in-house ELISA. Platelet counts were analysed in fresh blood using a Vetscan (Triolab). Transaminases were analysed by IDEXX BioResearch. Cytokines were analysed with V-plex Proinflammatory Panel 1 Mouse kit (MesoScale Discovery), including interferon (IFN)-γ, interleukin (IL)-1β, IL-2, IL, 4, IL-5, IL-6, IL-10, IL-12p70, KC/GRO and tumor necrosis factor (TNF)-α. Results Following administration of 200μg AT130-2 i.v., rapid onset of IRR was seen within 5-7 minutes. Blood sampling of these mice indicated reduced blood pressure. The mice recovered 10-15 minutes post IRR onset and no macroscopic symptoms were observed by 1h. Tolerability was dose-dependent and showed a clear pattern of increasing IRR with regards route of administration in the order s.c.<i.p.<i.v. When comparing PK and receptor occupancy with onset, severity and duration of IRR, there was a clear correlation between high dose and rapid increase in serum concentration, rather than FcγRIIB saturation. A decrease in platelet count was seen at the same time as IRRs after both i.v. and i.p. administration. The decrease was transient and normalised within 8h post injection. AST, ALT, IL-5, IL-6, IL-10 KC/GRO, TNF-α showed a transient increase, all peaking 1-3 post injection, except for IL-5. IL-5 showed a delayed peak 3-8h post injection. To investigate whether premedication with corticosteroids could inhibit the IRR and associated toxicities, mice were premedicated with betamethasone or dexamethasone 16-24h s.c. and 1h i.v. pre injection of AT130-2. Development of IRR and platelet reduction was completely inhibited with premedication. Also, the increase in liver transaminases and cytokine release was significantly reduced. A single dose of premedication at 1h pre injection did not inhibit the IRR nor prevent the decrease in platelet count, Whilst a single dose premedication 16-24h pre injection reduced the IRR and platelet decrease, it not completely block the changes, indicating that two doses of corticosteroids are optimal. Conclusions Here we demonstrate anin vivomodel that recapitulates the tolerability profile seen with BI-1206 in human cancer subjects, including IRR, decreased platelet count, elevated transaminases and transient cytokine release. In the mouse model, there was a correlation between IRR with high dose and rapid increase in serum concentration, rather than FcγRIIB saturation following administration of anti-FcγRIIB without IRR. This pre-medication regimen has been implemented in clinical trials and shown to improve tolerability to BI-1206. Disclosures Karlsson: BioInvent International AB:Current Employment.Mårtensson:BioInvent International AB:Current Employment, Current equity holder in publicly-traded company.Borggren:BioInvent International AB:Current Employment.Kovacek:BioInvent International AB:Current Employment, Current equity holder in publicly-traded company.Roos:BioInvent International AB:Current Employment.Blidberg:BioInvent International AB:Current Employment.Oldham:BioInvent International AB:Research Funding.Jerkeman:Roche:Research Funding;Abbvie:Research Funding;Janssen:Research Funding;Gilead:Research Funding;Celgene:Research Funding.Dyer:BioInvent International AB:Research Funding.Davies:Roche, Celgene, Kite Pharma, Acerta, Karyopharma, Regeneron, Incyte:Consultancy;Roche, Acerta Pharma, AstraZeneca, Celgene, Gilead, ADC Therapeutics, Gilead:Research Funding;Celegene, Roche, Kite Pharma, Celegene:Honoraria;Roche:Other: TRAVEL, ACCOMMODATIONS, EXPENSES.Córdoba:Roche:Honoraria, Other: travel and accommodation;Abbvie:Honoraria, Other: travel and accommodation;Janssen:Honoraria, Other: travel and accommodation;Takeda Farmacéutica España S.A.:Speakers Bureau;Gilead:Honoraria, Other: travel and accommodation.Abrisqueta:AbbVie:Consultancy, Honoraria, Speakers Bureau;Janssen:Consultancy, Honoraria, Speakers Bureau;Celgene:Consultancy, Honoraria;Roche:Consultancy, Honoraria, Speakers Bureau.Beers:BioInvent International AB:Research Funding.Teige:BioInvent International AB:Current Employment, Current equity holder in publicly-traded company.McAllister:BioInvent International AB:Current Employment, Current equity holder in publicly-traded company.Lim:BioInvent International AB:Patents & Royalties, Research Funding.Cragg:BioInvent International AB:Patents & Royalties, Research Funding.Frendéus:BioInvent International AB:Current Employment, Current equity holder in publicly-traded company.

Biochemical Bone Turnover Markers and Osteoporosis in Older Men: Where Are We?

In men aged less than 60, the association of serum and urinary levels of biochemical bone turnover markers (BTMs) and bone mineral density (BMD) is weak or not significant. After this age, higher BTM levels are correlated weakly, but significantly, with lower BMD and faster bone loss. Limited data from the cohort studies suggest that BTM measurement does not improve the prediction of fragility fractures in older men in comparison with age, BMD, history of falls and fragility fractures. Testosterone replacement therapy (TRT) decreases bone resorption. During TRT, bone formation markers slightly increase (direct effect on osteoblasts), then decrease (slowdown of bone turnover). Bisphosphonates (alendronate, risedronate, ibandronate, zoledronate) induce a rapid decrease in bone resorption followed by a milder decrease in bone formation. In men receiving antiresorptive therapy for prostate cancer, zoledronate, denosumab and toremifene decrease significantly levels of bone resorption and bone formation markers. Teriparatide induced a rapid increase in serum concentrations of bone formation markers followed by an increase in bone resorption. We need more studies on the utility of BTM measurement for the improvement of the persistence and adherence to the anti-osteoporotic treatment in men.

Dose Dependency and Individual Variability of the Lipopolysaccharide-Induced Bovine Acute Phase Protein Response

In order to investigate the dose dependency and the individual variability of the lipopolysaccharide (LPS)-induced acute phase protein response in cattle, 8 nonlactating, nonpregnant Danish Holstein cows were challenged 3 times each by intravenous injection of increasing doses (10, 100, and 1000 ng/kg, consecutively) of Escherichia coli LPS with 3-wk intervals. All 3 LPS doses resulted in a rapid increase in serum concentrations of haptoglobin and serum amyloid A (SAA) and a decrease in serum concentrations of albumin in all 8 cows. Serum concentrations of acute phase proteins (APP) remained altered for several days after each LPS injection, and their increase or decrease was significantly related to LPS dose. In addition to dose dependency, the response was also dependent on the individual, as APP concentrations differed significantly among cows. To compare APP production in 2 consecutive challenges, individual APP levels after the challenge with 100ng LPS/kg were correlated to levels attained after the challenge with 1000ng LPS/kg. Serum amyloid A concentrations correlated between the 2 challenges, whereas haptoglobin concentrations tended to correlate; no correlation could be demonstrated between SAA and haptoglobin concentrations in either of the challenges, which suggests that the synthesis of haptoglobin and SAA are regulated in different ways. In conclusion, cattle are highly susceptible to LPS, as very low doses of LPS elicited acute phase albumin, SAA, and haptoglobin responses. Concentrations of APP not only reflect the magnitude of LPS exposure but are also influenced by the ability of the individual cow to mount an acute phase response. The ability to produce SAA and haptoglobin may be an innate characteristic of the individual, as responses in consecutive challenges were quantitatively similar.

Effects of Acidification and Storage of Milk on Dissociation of Bovine Casein Micelles

The effects of acidification and storage of skim-milk on the rate and extent of solubilization of colloidal calcium phosphate and dissociation of caseins from the micelles were examined. As the pH was reduced, calcium phosphate was progressively removed from the micelles, and after each pH adjustment there was an initial rapid increase in serum concentrations of Ca and inorganic phosphate, but only a slight further increase on storage. The extent of disssociation of the caseins from the micelles on acidification was temperature-dependent. At 30 °C, concentrations of serum casein remained low, but at 20 °C, and especially at 4 °C, the levels of all caseins increased in the serum as the pH was reduced to about pH 5.5 and 5.2, respectively. After each pH adjustment, there was an initial rapid increase in the serum concentrations of the caseins and a more gradual increase on storage up to 24 h. Keywords: Calcium phosphate; casein; dissociation; pH

Effect of Oxytocin on Concentrations of Prostaglandin H Synthase-2 mRNA in Ovine Endometrial Tissue in Vivo

Oxytocin is an acute stimulus of prostaglandin (PG) F2α secretion from the ovine uterine endometrium. The high level of PGF2α secretion induced by oxytocin and the short half-life of the prostaglandin synthase-2 (PGHS-2) enzyme implies that synthesis of PGHS-2 may be essential at this time. The objective of this study was to determine if the increase in PGF2α secretion induced by oxytocin is associated with an increase in PGHS-2 mRNA. In experiment 1, oxytocin induced a rapid increase in serum concentration of 13,14-dihydro-15-keto-prostaglandin F2α (the stable metabolite of PGF2α; PGFM) that was detected within 7.5 min (P < 0.05) and peaked at 25 min post injection. This was associated with an unusually rapid increase in the concentration of PGHS-2 mRNA at 25 min post oxytocin injection (P < 0.05). Endometrial concentrations of PGHS-2 mRNA returned to basal levels at 90 min post injection. Experiment 2 was conducted to further characterize the time course of induction of PGHS-2 mRNA following oxytocin administration. Oxytocin induced a rapid increase in serum concentrations of PGFM. As in experiment 1, an increase in concentrations of PGHS-2 mRNA was detected at 25 min after oxytocin (P = 0.06). Concentrations of PGHS-2 mRNA were intermediate at 40 min and returned to basal levels at 60 min post injection. Thus, there is a rapid increase in endometrial concentrations of PGHS-2 mRNA following oxytocin stimulation of PGF2α secretion. This increase in PGHS-2 mRNA may be required to maintain PGHS-2 enzyme levels during pulsatile secretion of PGF2α at luteolysis.

Effect of oxytocin on concentrations of prostaglandin H synthase-2 mRNA in ovine endometrial tissue in vivo.

Oxytocin is an acute stimulus of prostaglandin (PG) F2alpha secretion from the ovine uterine endometrium. The high level of PGF2alpha secretion induced by oxytocin and the short half-life of the prostaglandin synthase-2 (PGHS-2) enzyme implies that synthesis of PGHS-2 may be essential at this time. The objective of this study was to determine if the increase in PGF2alpha secretion induced by oxytocin is associated with an increase in PGHS-2 mRNA. In experiment 1, oxytocin induced a rapid increase in serum concentration of 13,14-dihydro-15-keto-prostaglandin F2alpha (the stable metabolite of PGF2alpha; PGFM) that was detected within 7.5 min (P < 0.05) and peaked at 25 min post injection. This was associated with an unusually rapid increase in the concentration of PGHS-2 mRNA at 25 min post oxytocin injection (P < 0.05). Endometrial concentrations of PGHS-2 mRNA returned to basal levels at 90 min post injection. Experiment 2 was conducted to further characterize the time course of induction of PGHS-2 mRNA following oxytocin administration. Oxytocin induced a rapid increase in serum concentrations of PGFM. As in experiment 1, an increase in concentrations of PGHS-2 mRNA was detected at 25 min after oxytocin (P = 0.06). Concentrations of PGHS-2 mRNA were intermediate at 40 min and returned to basal levels at 60 min post injection. Thus, there is a rapid increase in endometrial concentrations of PGHS-2 mRNA following oxytocin stimulation of PGF2alpha secretion. This increase in PGHS-2 mRNA may be required to maintain PGHS-2 enzyme levels during pulsatile secretion of PGF2alpha at luteolysis.

Annual changes in serum concentrations of prolactin in captive male black bears (Ursus americanus)

Prolactin may be involved in the regulation of reproduction in black bears (Ursus americanus) as it is a mediator of photoperiodic changes in a number of species. The objectives of this study were to validate a radioimmunoassay to measure prolactin in bear serum and to describe seasonal changes in serum prolactin concentrations in captive male bears. Serum samples were obtained nine times during a year from three captive male black bears that were denning between November and March and active during the other months. The heterologous prolactin radioimmunoassay, using pig 125I-labelled prolactin and goat anti-pig prolactin as a primary antibody, was validated. Injection of thyrotrophin-releasing hormone into the three male bears in June resulted in a rapid increase in serum concentrations of prolactin (t = 0, 11.4-14.8 ng ml-1; t = 15-30 min, 18.4-28.7 ng ml-1). The sensitivity of the assay was 0.08 ng per tube. Intra- and interassay coefficients of variation were 5.5% (n = 6) and 5.7% (n = 6), respectively. Serum concentrations of prolactin changed seasonally, with the lowest concentrations in December (mean +/- SD = 1.1 +/- 0.1 ng ml-1); this was followed by a gradual increase between January (2.6 +/- 0.6 ng ml-1) and April (6.4 +/- 1.2 ng ml-1) and the highest concentrations in May (17.6 +/- 4.7 ng ml-1), preceding peak testosterone concentrations in June. The observation that prolactin secretion increased with increasing daylength suggests that photoperiod may be an external regulator. The presence of high concentrations of prolactin before peak testosterone concentrations suggests that prolactin may play a role in regulating seasonal changes in the testes.

Pharmacokinetics and hematologic response to subcutaneous administration of recombinant human erythropoietin in children undergoing long-term peritoneal dialysis: A multicenter study

For a study of the pharmacokinetics and hematologic response of subcutaneously administered recombinant human erythropoietin (rHuEPO), 24 children (mean age, 10 years 3 months; range, 3 months to 18 years) maintained by peritoneal dialysis and with anemia caused by end-stage renal failure (mean hemoglobin level, 6.5 gm/dl; range, 4.7 to 7.9) were treated with rHuEPO administered subcutaneously at an initial dose of 25 IU/kg twice per week. After a 4-week interval, in the case of no response (hemoglobin increase < or = 1 to 1.5 gm/dl per month) the rHuEPO dosage was increased every 4 weeks according to the following schedule: 50, 75, 100, and 150 IU/kg twice per week. The administration of rHuEPO produced a rapid increase in serum concentration with a mean peak level of 59.8 mU/ml after 9 hours. Mean area under the curve to 72 hours was 2020 mU/ml per hour (range, 568 to 6609); mean elimination half-life and mean residence time were, respectively, 25.2 hours (range, 6.2 to 58.7) and 42.0 hours (range, 10.9 to 96). Of 24 children entered in the study, six had the drug suspended early because of renal transplantation (n = 1), lack of compliance (n = 4), or severe worsening of hypertension (n = 1). Eighteen patients had increased hemoglobin levels (to 9.4 +/- 1.7 gm/dl after 24 weeks of treatment). No correlation was found between the increase in hemoglobin concentration and any of the pharmacokinetic data or the peak erythropoietin level reached during the kinetic profile. Eight children required an increase of antihypertensive medications to maintain satisfactory blood pressure values. We conclude that low doses of subcutaneously administered rHuEPO slowly release the drug into the blood and satisfactorily increase hemoglobin levels with very few side effects.

EFFECTS OF THE RECTAL ADMINISTRATION OF DIAZEPAM: Diazepam Concentrations in Children Undergoing General Anaesthesia

Diazepam 1 mg/kg body weight was administered rectally to 14 children (11-22.5 kg) before minor surgery under general anaesthesia. Administration in solution (n = 7) resulted in a rapid increase in serum concentrations which were maintained for 8 h. Administration by suppository (n = 7) resulted in significantly lower serum concentrations at 10 and 20 min, but higher concentrations at 2 h. At other intervals the concentrations did not differ from those reached after administration of diazepam in rectal solution. These results favour for use of a solution when rectal diazepam is used for premedication in children.