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Background:Despite advances in the treatment of lymphoma in recent years, unmet medical needs remain, particularly for patients with R/R disease and rarer subtypes of non‐Hodgkin lymphoma (NHL). The alkylating deacetylase inhibitor tinostamustine (EDO‐S101) is a novel multi‐action therapy that is designed to improve drug access to DNA strands, and at the same time induce DNA damage and counteract its repair in cancer cells.Aims:Here we report findings from the dose‐escalation stage of a Phase I first‐in‐human study to evaluate the safety and pharmacokinetics, and to determine the maximum tolerated dose (MTD) and recommended Phase II dose (RP2D), of tinostamustine in patients with R/R lymphoid malignancies (NCT02576496).Methods:Patients were recruited using a standard 3+3 design, with the first cohort receiving 20 mg/m2 tinostamustine administered iv over 60 minutes, with six ascending cohorts, to a maximum dose of 120 mg/m2. Dose‐limiting toxicities (DLT) were defined as: any Grade (G) 3 or 4 non‐haematological toxicity (excluding alopecia and easily correctable electrolyte abnormalities); nausea, vomiting or diarrhoea ≥10 days despite aggressive symptomatic treatment; G4 neutropenia or thrombocytopenia for ≥7 days; any G2 or more toxicity for >3 weeks; any toxicity resulting in a delay of the next dose administration (Cycle 2 Day 1 ≥14).Results:A total of 27 patients with lymphoid malignancies were enrolled into the study, 10 of these patients were diagnosed with R/R Hodgkin lymphoma (HL) and 17 with NHL, including peripheral T‐cell lymphoma and diffuse large B‐cell lymphoma. The MTD of tinostamustine was determined to be 100 mg/m2; shorter infusion times were evaluated in three cohorts of patients, but the recommended infusion time was confirmed as 60 minutes. Safety findings for each dose cohort for HL and NHL patients were mainly haematological toxicities: G3/4 thrombocytopenia, neutropenia and leucopenia, with incidence increasing with increasing dose. One patient experienced a G3 allergic reaction. Signals of efficacy were observed among the 27 patients with lymphoma (overall response rate [ORR] 41% [11 patients]; clinical benefit rate [CBR] 67% [18 patients]). The best response, as determined by the Investigator, was complete response (CR; 3/27 patients [11%]), which was observed in one patient with HL and two with NHL; partial response (PR; 8/27 patients [30%]) and stable disease (SD; 7/27 patients [26%]) were also observed. Nine of the 27 patients (33%) had disease progression.Summary/Conclusion:Administration of tinostamustine on Day 1 of a 21‐day cycle was well tolerated with signals of efficacy in patients with both HL and NHL, including rare forms of NHL such as peripheral T‐cell lymphoma. The RP2D for tinostamustine in lymphoid malignancies, depending on patient platelet count at treatment initiation, was determined as 80 mg/m2 for those with >100 x 109/l platelets, and 100 mg/m2 for those with ≥200 x 109/l platelets. This will be applied in the second phase of this study, where patients will be recruited into one of five different cohorts.

When isolated neonatal pig livers were perfused with blood from pigs with von Willebrand’s disease, no factor VIII coagulant activity (VIII:C) emerged in the perfusate. When purified porcine Willebrand factor, lacking VIII:C, was added to the perfusate it rapidly diminished, presumably being taken up by the liver. Concurrently VIII:C rose steadily in the blood during the 5 hours of perfusion. Similarly, isolated adult rat livers released no VIII:C when they were perfused with rat erythrocytes suspended in Tyrode’s solution containing 6% bovine serum albumin. VIII:C did emerge if cryoprecipitate from aged rat plasma were added. The neo-VIII:C was rapidly inactivated by plasma from a patient with classic hemophilia who had developed an antibody to VIII:C Addition of cycloheximide to the rat before extirpation of the liver, as well as to the perfusate, prevented the emergence of VIII:C. We suspect that VIII:C is derived from the liver but only when Willebrand factor is present.

Thrombin Quick (TQ) may be isolated following treatment of Prothrombin Quick [Owen, et al, Mayo Clinic Proceedings, 53: 29-33, (1978)] with Taipan venom, phospholipid and ca2+. The clotting activity of TQ with fibrinogen is 1/200 that of nornar thrombin (T). The activation of Factors V and VIII, and the aggregation of platelets by TQ occurs with an effectiveness of about 1/50 that of thrombin. when incubated with antithrombin III, both T ad TQ fom inhibitor complexes as determined by dodecylsulfate gel electropheresis. Titration of T and TQ with the fluorescent inhibitor dansylarginine-4-ethylpiperidine amide indicates an equivalent number of active sites based on protein absorption at 280 nm. However, the two enzymes may be distinquished by the decreased fluorescence enhancement observed with TQ relative to T, indicating an increased polarity in the inhibitor binding site of TQ. With the substrate benzoylarginine ethylester, TQ has a Km = 4.5 × 10-5M and kcat= 6.93 compared to Km = 4.0 × 10-5M and kcat= 17.7 for T. This indicates that the defect in TQ esterase activity is in the catalytic mechanism itself and not in substrate binding. The rate of inhibition of TQ by diisopropylphosphofluoridate is decreased. Decreased acylation and deacylation rates for TQ relative to T are observed for hydrolysis of the active site titrant 4-methykl-umbelliferyl-p-guanidinobenzoate

AbstractIntroductionOur primary goal was to examine demographic and clinicopathologic differences across an ethnoracially diverse autopsy‐confirmed cohort of Alzheimer's disease cases.MethodsA retrospective study was conducted in the Florida Autopsied Multi‐Ethnic cohort on 1625 Alzheimer's disease cases, including decedents who self‐reported as Hispanic/Latino (n = 67), black/African American (n = 19), and white/European American (n = 1539).ResultsHispanic decedents had a higher frequency of family history of cognitive impairment (58%), an earlier age at onset (median age of 70 years), longer disease duration (median of 12 years), and lower MMSE proximal to death (median of 4 points) compared with the other ethnoracial groups. Black decedents had a lower Braak tangle stage (stage V) and higher frequency of coexisting hippocampal sclerosis (21%); however, only hippocampal sclerosis differences survived adjustment for sex, age at onset, and disease duration. Neither Thal amyloid phase nor coexisting Lewy body disease differed across ethnoracial groups.DiscussionDespite a smaller sample size, Hispanics demonstrated longer disease duration with Alzheimer's disease, but not greater lifespan. Neuropathologic differences across ethnoracial groups supported differences in tau pathology distribution and coexisting hippocampal sclerosis, which may impact biomarker studies.

Introduction: Across 269 international sites, the POINT trial randomly assigned 4881 patients with minor ischemic stroke or high-risk transient ischemic attack to receive either clopidogrel at a loading dose of 600 mg on day 1 followed by 75 mg per day, plus aspirin at a dose of 50-325 mg per day or the same range of doses of aspirin alone. Dual antiplatelet therapy significantly reduced the incidence of major ischemic events, but also significantly increased the incidence of major hemorrhage. Clopidogrel is a prodrug that requires metabolism by the cytochrome P450 complex to act on the P2Y12 platelet receptor. CYP2C19 (cytochrome P450 family 2 subfamily C polypeptide 19) variants are associated with variable rates of metabolism of clopidogrel and thus pharmacogenomic effects may be clinically relevant. Methods: Genomic DNA was extracted from peripheral blood monocytes using the standard protocols. Genotyping for CYP2C19 *2, *3 and *17 alleles (rs4244285, rs4986893 and rs12248560) defines metabolizer/activator status and was performed using custom TaqMan Allelic Discrimination Assays on a QuantStudio™ 7 Flex Real-Time PCR System. Results: As of June 28, 2018, a total of 445 trial participants had DNA available for analysis. CYP2C19 allele genotyping demonstrated approximately one quarter of subjects (n=127; 28.6%) would be defined as poor or Intermediate metabolizers of clopidogrel. Conclusions: Based on targeted cytochrome P 450 genotyping, about one quarter of POINT patients have reduced clopidogrel activation. Additional genotyping is ongoing. We plan to present results assessing whether the treatment effect of clopidogrel is limited to those with CYP2C19 genotypes associated with normal drug metabolism.