varicella zoster immunoglobulin (VariQuin)

[Intrathecal immunoglobulin administration for refractory viral central nervous system infection after allogeneic hematopoietic stem cell transplantation].

Matsuo Masaaki M, Kusakabe Shinsuke S, Kurashige Ryumei R, Fukushima Kentaro K et al.

Central nervous system (CNS) viral infections after allogeneic hematopoietic stem cell transplantation are associated with poor prognosis and have limited therapeutic options. We report three cases of refractory CNS viral infection treated by combination therapy with antiviral agents and intrathecal immunoglobulin administration. Case 1 involved cytomegalovirus encephalitis, Case 2 varicella zoster virus meningitis, and Case 3 human herpesvirus 6 encephalitis; all were resistant to antiviral agents. Two patients achieved viral DNA negativity in cerebrospinal fluid, and none experienced adverse events related to intrathecal injection. Although no intrathecal immunoglobulin products have been approved for use in Japan, our findings suggest that this treatment may be a viable option in selected refractory cases. Further studies are warranted to clarify the optimal agent, dosage, and schedule.

Reversible temporal artery halo sign in polymerase chain reaction-confirmed herpes zoster ophthalmicus without corticosteroid exposure.

Yang Howard Jie HJ, Lin Emily Yiming EY, Deva Rajeev R, Morand Eric E

Outcomes of tofacitinib dose reduction in patients with ulcerative colitis in stable remission: a long-term follow-up of the randomized RIVETING trial.

Rubin David T DT, Panés Julian J, Torres Joana J, Kobayashi Taku T et al.

Tofacitinib is an oral Janus kinase inhibitor used for the treatment of ulcerative colitis. This study evaluated efficacy/safety of dose reduction to tofacitinib 5 mg twice daily (BID) versus remaining on 10 mg BID in patients in stable remission on 10 mg BID. RIVETING, a phase 3b/4, double-blind, randomized, parallel-group trial, enrolled patients in stable remission (≥6 months) and corticosteroid-free (≥4 weeks) who received tofacitinib 10 mg BID for ≥2 years. Efficacy was reported to month (M)30 and safety was reported throughout. One hundred and forty patients were randomized (1:1) to tofacitinib 5 or 10 mg BID; 50.0% and 62.9%, respectively, maintained modified Mayo score remission at M30. Remission rate differences at M30 between doses were generally greater in patients with a baseline endoscopic subscore of 1 versus 0, and with versus without tumor necrosis factor inhibitor (TNFi) failure. 11/14 patients who dose-escalated from 5 to 10 mg BID following relapse recaptured remission (median 4.8 months). Serious infection and herpes zoster incidence rates were numerically higher with tofacitinib 10 versus 5 mg BID; overall, adverse event rates were generally similar between doses. Patients on tofacitinib 10 mg BID generally maintained modified Mayo score remission through M30 after reduction to 5 mg BID; most patients who relapsed recaptured remission after dose-escalating back to 10 mg BID. Efficacy was more likely to be maintained following dose reduction in patients with baseline endoscopic subscore 0 versus 1, without versus with prior TNFi failure. Serious infection and herpes zoster incidence was higher with tofacitinib 10 versus 5 mg BID, consistent with known safety profile. NCT03281304.

Proteomic insights into goat milk serum proteins at varying altitudes in China.

Li Zhaomin Z, Wang Shanshan S, Cao Hanwen H, Yan Yingying Y et al.

Using Astral DIA quantitative proteomics, this study characterized serum protein profiles and potential functions of goat milk from different altitude regions. A total of 1446 proteins were identified, with 1268, 1256, and 1346 proteins detected in high-altitude, mid-altitude, and low-altitude samples, respectively. The high-altitude sample contained 34 unique proteins and showed higher abundances of α-lactalbumin, serum albumin, and polymeric immunoglobulin receptor, whereas the low-altitude sample contained 87 unique proteins and higher abundances of several immune-related proteins, including osteopontin, lactoferrin, immunoglobulin, lysozyme, xanthine oxidase, lactoperoxidase, and GLYCAM1. Differentially expressed analysis identified 453, 452, and 113 differential proteins in high-altitude vs. low-altitude, mid-altitude vs. low-altitude, and high-altitude vs. mid-altitude comparisons, respectively. KEGG analysis showed that carbohydrate metabolism was enriched in comparisons involving the low-altitude sample, whereas amino acid metabolism was enriched between high-altitude and mid-altitude samples. Notably, HIF-1 signaling pathway was enriched in the high-altitude sample, suggesting hypoxia-associated proteomic adaptation.