Vedolizumab: an α4β7 integrin antagonist for ulcerative colitis and Crohn’s disease

Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic, relapsing inflammatory bowel diseases associated with significant morbidity. Conventional therapies for these diseases include corticosteroids, aminosalicylates, immunomodulators, and monoclonal antibodies. Over the years tumor necrosis factor (TNF)-α antagonists alone or in combination with other therapies have emerged as the cornerstone of treatment for induction and maintenance of remission of moderate to severe UC and CD. Unfortunately, some patients with moderate to severe UC and CD are unable to attain or maintain remission with TNF-α antagonist treatment. Vedolizumab, a humanized monoclonal antibody, is the first integrin receptor antagonist approved that selectively antagonizes α4β7 gastrointestinal integrin receptors. US Food and Drug Administration approval is for treatment of patients with moderate to severe active UC and CD who have inadequate response with, lost response to, or are intolerant to a TNF-α antagonist or an immunomodulator; or have inadequate response with, are intolerant to, or demonstrate dependence on corticosteroids. When administered according to approved dosing in patients with moderate to severe CD and UC, vedolizumab induces clinical response rates up to 31.4% and 47.1% at week 6, and clinical remission rates up to 39% and 41.8% at week 52, respectively. Serious adverse events reported with vedolizumab include serious infections, malignancies, and anaphylaxis. Since vedolizumab is gastrointestinal selective, to date, it has not shown evidence of causing progressive multifocal leukoencephalopathy; however, postmarketing studies monitoring for this adverse effect are ongoing. Further assessment of vedolizumab earlier in the course of these diseases and in combination with other therapies is warranted

TWEAK/Fn14 Signaling Axis Mediates Skeletal Muscle Atrophy and Metabolic Dysfunction

doi: 10.3389/fimmu.2014.00018 TWEAK/Fn14 signaling axis mediates skeletal muscle atrophy and metabolic dysfunctio

Modelling short-rotation coppice and tree planting for urban carbon management - a citywide analysis

© 2015 British Ecological Society The capacity of urban areas to deliver provisioning ecosystem services is commonly overlooked and underutilized. Urban populations have globally increased fivefold since 1950, and they disproportionately consume ecosystem services and contribute to carbon emissions, highlighting the need to increase urban sustainability and reduce environmental impacts of urban dwellers. Here, we investigated the potential for increasing carbon sequestration, and biomass fuel production, by planting trees and short-rotation coppice (SRC), respectively, in a mid-sized UK city as a contribution to meeting national commitments to reduce CO2 emissions. Iterative GIS models were developed using high-resolution spatial data. The models were applied to patches of public and privately owned urban greenspace suitable for planting trees and SRC, across the 73 km2 area of the city of Leicester. We modelled tree planting with a species mix based on the existing tree populations, and SRC with willow and poplar to calculate biomass production in new trees, and carbon sequestration into harvested biomass over 25 years. An area of 11 km2 comprising 15% of the city met criteria for tree planting and had the potential over 25 years to sequester 4200 tonnes of carbon above-ground. Of this area, 5·8 km2 also met criteria for SRC planting and over the same period this could yield 71 800 tonnes of carbon in harvested biomass. The harvested biomass could supply energy to over 1566 domestic homes or 30 municipal buildings, resulting in avoided carbon emissions of 29 236 tonnes of carbon over 25 years when compared to heating by natural gas. Together with the net carbon sequestration into trees, a total reduction of 33 419 tonnes of carbon in the atmosphere could be achieved in 25 years by combined SRC and tree planting across the city. Synthesis and applications. We demonstrate that urban greenspaces in a typical UK city are underutilized for provisioning ecosystem services by trees and especially SRC, which has high biomass production potential. For urban greenspace management, we recommend that planting SRC in urban areas can contribute to reducing food-fuel conflicts on agricultural land and produce renewable energy sources close to centres of population and demand

Genetic associations of protein-coding variants in human disease

Genome-wide association studies (GWAS) have identified thousands of genetic variants linked to the risk of human disease. However, GWAS have so far remained largely underpowered in relation to identifying associations in the rare and low-frequency allelic spectrum and have lacked the resolution to trace causal mechanisms to underlying genes(1). Here we combined whole-exome sequencing in 392,814 UK Biobank participants with imputed genotypes from 260,405 FinnGen participants (653,219 total individuals) to conduct association meta-analyses for 744 disease endpoints across the protein-coding allelic frequency spectrum, bridging the gap between common and rare variant studies. We identified 975 associations, with more than one-third being previously unreported. We demonstrate population-level relevance for mutations previously ascribed to causing single-gene disorders, map GWAS associations to likely causal genes, explain disease mechanisms, and systematically relate disease associations to levels of 117 biomarkers and clinical-stage drug targets. Combining sequencing and genotyping in two population biobanks enabled us to benefit from increased power to detect and explain disease associations, validate findings through replication and propose medical actionability for rare genetic variants. Our study provides a compendium of protein-coding variant associations for future insights into disease biology and drug discovery. A meta-analysis combining whole-exome sequencing data from UK Biobank participants and imputed genotypes from FinnGen participants enables identification of genetic associations with human disease in the rare and low-frequency allelic spectrumPeer reviewe

Genetic associations of protein-coding variants in human disease.

Genome-wide association studies (GWAS) have identified thousands of genetic variants linked to the risk of human disease. However, GWAS have so far remained largely underpowered in relation to identifying associations in the rare and low-frequency allelic spectrum and have lacked the resolution to trace causal mechanisms to underlying genes1. Here we combined whole-exome sequencing in 392,814 UK Biobank participants with imputed genotypes from 260,405 FinnGen participants (653,219 total individuals) to conduct association meta-analyses for 744 disease endpoints across the protein-coding allelic frequency spectrum, bridging the gap between common and rare variant studies. We identified 975 associations, with more than one-third being previously unreported. We demonstrate population-level relevance for mutations previously ascribed to causing single-gene disorders, map GWAS associations to likely causal genes, explain disease mechanisms, and systematically relate disease associations to levels of 117 biomarkers and clinical-stage drug targets. Combining sequencing and genotyping in two population biobanks enabled us to benefit from increased power to detect and explain disease associations, validate findings through replication and propose medical actionability for rare genetic variants. Our study provides a compendium of protein-coding variant associations for future insights into disease biology and drug discovery

What is the risk of progressive multifocal leukoencephalopathy in patients with ulcerative colitis or Crohn’s Disease treated with vedolizumab?

Background: Progressive multifocal leukoencephalopathy is a serious condition linked to certain diseases and immunosuppressant therapies, including the α4 integrin antagonist natalizumab. No cases have been reported to date with vedolizumab, a selective antagonist of the α4β7 integrin expressed on gut-homing lymphocytes. This analysis aimed to describe the current and future expected occurrence of progressive multifocal leukoencephalopathy with vedolizumab use, were the risk the same as in other populations in which this disease has been studied. Methods: The expected number of vedolizumab-associated progressive multifocal leukoencephalopathy cases was estimated up to May 19, 2016 and modelled up to 2034. These estimates were based on the cumulative exposure to the drug, assuming an equivalent risk to that of patients treated with natalizumab or those from other reference populations where progressive multifocal leukoencephalopathy has been examined. Future cases were modelled based on similar risks and projected sales. Results: The cumulative vedolizumab exposure was estimated at 54,619 patient-years, with a 95% confidence interval of 0.0–6.75 cases per 100,000 patient-years. An estimated 30.2 (95% confidence interval 19.4–40.9) cases of progressive multifocal leukoencephalopathy would have occurred if vedolizumab had the same risk as that of natalizumab. There would be a 50% chance of the first case occurring by 2018, assuming an equivalent risk to the general population. Conclusions: These analyses indicate the risk of progressive multifocal leukoencephalopathy with vedolizumab is small, and unlikely to be above 6.75 cases per 100,000 patient-years

Switching Patients from Originator to Biosimilar Medications in Rheumatoid Arthritis: Limiting the ‘Nocebo’ Effect

Biosimilars have been available in Europe since 2006, and biosimilars of monoclonal antibodies since 2013, and are now a widespread clinical reality. Since their introduction, various sources of data have become available to help physicians make knowledgeable decisions about their use. For example, randomised clinical trials can demonstrate the comparable efficacy and safety between the biosimilar and its reference biologic. Real-world evidence from registries and individual clinical centres provide additional data on the actual use of biosimilars across different therapeutic indications and broader patient populations, including those who have switched from the reference biologic to the biosimilar, while offering additional understanding of the long-term safety and effectiveness. Well-informed decisions based on a solid understanding of these data are important and can help the physician guide the patient to their own well-informed decision, thereby reducing the possibility of a nocebo effect. Here we review available data sources and look at best practice examples of communicating with patients