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Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder which presents with isolated thrombocytopenia and risk of hemorrhage. While most children with ITP promptly recover with or without drug therapy, ITP is persistent or chronic in others. When needed, how to select second-line therapies is not clear. ICON1, conducted within the Pediatric ITP Consortium of North America (ICON), is a prospective, observational, longitudinal cohort study of 120 children from 21 centers starting second-line treatments for ITP which examined treatment decisions. Treating physicians reported reasons for selecting therapies, ranking the top three. In a propensity weighted model, the most important factors were patient/parental preference (53%) and treatment-related factors: side effect profile (58%), long-term toxicity (54%), ease of administration (46%), possibility of remission (45%), and perceived efficacy (30%). Physician, health system, and clinical factors rarely influenced decision-making. Patient/parent preferences were selected as reasons more often in chronic ITP (85.7%) than in newly diagnosed (0%) or persistent ITP (14.3%, P = .003). Splenectomy and rituximab were chosen for the possibility of inducing long-term remission (P < .001). Oral agents, such as eltrombopag and immunosuppressants, were chosen for ease of administration and expected adherence (P < .001). Physicians chose rituximab in patients with lower expected adherence (P = .017). Treatment choice showed some physician and treatment center bias. This study illustrates the complexity and many factors involved in decision-making in selecting second-line ITP treatments, given the absence of comparative trials. It highlights shared decision-making and the need for well-conducted, comparative effectiveness studies to allow for informed discussion between patients and clinicians.

A scalable synthesis of calix[n]furan[4-n]pyrroles and their fully reduced analogues, the novel calix[n]tetrahydrofuran[4-n]pyrrolidines obtained by hydrogenation of their aromatic relatives, was developed and optimized. The hydrogenation reaction was studied at several selected pressures (P = 100, 50 and 15 bars) and high diastereoselectivity was observed for the four possible calix[n]tetrahydrofuran[4-n]pyrrolidines. Moreover, two of the saturated macrocycles were obtained with good overall yields starting from the easily accessible calix[4]furan. The conformation of the eight macrocycles was analysed by X-ray diffraction and while a classical 1,3-alternate conformation of this type of compound was observed for the aromatic macrocycles, two distinct types of conformation were observed with the calix[n]tetrahydrofuran[4-n]pyrrolidines.

Over the years a significant amount of effort has been put into the development of rapid and reliable methods to monitor the aggregation dynamics of the β1-42 amyloid peptide in real time. We present an alternative approach based on a suitable reporter or spy molecule and three different NMR experiments: WaterLOGSY, 1 H selective T1 filter, and 19 F T2 filter, for monitoring the initial self-aggregation process kinetics of the β1-42 amyloid peptide and identifying molecules that retard or accelerate the self-aggregation process. Although the proposed method is not a high-throughput assay, it avoids problems associated with interference events that are sometimes observed in fluorescence-based assays.

The defense system of a plant can be primed for increased defense, resulting in an augmented stress resistance and/or tolerance. Priming can be triggered by biotic and abiotic stimuli, as well as by chemicals such as β-aminobutyric acid (BABA), a nonprotein amino acid considered so far a xenobiotic. Since the perception mechanism of BABA has been recently identified in Arabidopsis thaliana, in the present study we explored the possibility that plants do synthesize BABA. After developing a reliable method to detect and quantify BABA in plant tissues, and unequivocally separate it from its two isomers α- and γ-aminobutyric acid, we measured BABA levels in stressed and nonstressed A. thaliana plants, and in different plant species. We show that BABA is a natural product of plants and that the endogenous levels of BABA increase rapidly after infection with necrotrophic, biotrophic and hemibiotrophic pathogens, as well as after salt stress and submergence. Our results place the rise in endogenous BABA levels to a point of convergence in plant stress response and provide biological significance to the presence of a receptor in plants. These findings can explain the extremely widespread efficacy of BABA and open the way to unravel the early steps of priming.

The self-assembly of N,N′,N″-trialkylbenzene-1,3,5-tricarboxamides (BTAs) 1 or of “crowded” BTAs 11 and 12 lead to supramolecular columnar-stacked structures with attractive material properties. The introduction of three alkoxy groups is reported to reinforce the self-assembly process. The influence of a single substituent introduced onto the aromatic core of BTA significantly affects the self-assembly process. The aggregation process of 2-substituted BTAs in the bulk and in solution, as studied by DSC, POM, X-ray diffraction and 1H NMR experiments, is impaired by hydrogen-bond-accepting substituents but strengthened by non-hydrogen-bond-accepting substituents.

The biaryl core structure of rhazinilam with its fixed dihedral angle is a pivotal element for its unique in vitro cytotoxic activity. Most of the related natural products are oxidized versions of rhazinilam. Replacing the sensitive pyrrole ring by a pyrrolinone ring is the basis of our initial strategy towards rhazinilam analogues. With this goal, variants of the sequence crossed Mukaiyama aldol reaction followed by the Staudinger reaction were studied. Reacting a suitably substituted acetophenone with O-methyl O-trimethylsilyl ketene acetal gave pyrrolinones 8a and 8b in good to excellent yields. These intermediates could be transformed in four high-yielding steps into the pyrrolic precursors 7a–c containing all the atoms necessary for the construction of rings A, B, and C of rhazinilam. Our studies illustrate a lack of stability of these intermediates. Alternative synthetic approaches towards this central biaryl core structure are described.

We surveyed 278 pediatric hematologists/oncologists regarding how children with immune thrombocytopenia (ITP) are counseled for participation in sports. Results show substantial variation in physician perception of contact risk for different sports, and the advice offered about restriction of sport activities of affected children. Many physicians recommend restriction of sports when platelet counts are under 50 × 10(9) /L. Such restriction may affect the child's quality of life despite their having an overall benign disease.

Abstract 3681 Background: Pediatric Immune Thrombocytopenia (ITP) has an incidence of 4–6/100,000 with 1/3 of cases becoming chronic. Treatment choice is arbitrary, because few studies are powered to identify predictors of therapy response. Increasingly, rituximab is becoming a treatment of choice in those refractory to other therapies (Neunert CE, et al. Pediatr Blood Cancer 2008; 51(4):513). Previous studies in ITP have not examined predictors of response to rituximab or whether response to prior treatments predicts response. Objective: To evaluate univariate and multivariable predictors of platelet count response to rituximab. Methods: After local IRB approval, 550 patients with chronic ITP enrolled in the longitudinal, North American Chronic ITP Registry (NACIR) between January 2004 and June 2010. Eligibility included: ages 6 months-18 years at ITP diagnosis, clinical diagnosis of ITP, and ITP duration >6 months. Primary ITP was defined as isolated thrombocytopenia without associated conditions. Secondary ITP included those patients with immune thrombocytopenia associated with other immune-mediated medical conditions, including Evans Syndrome. Treatment response was defined as a post-treatment platelet count ≥50,000/uL within 16 weeks of rituximab and within 14 days of steroids. Steroids were prescribed as 1–4 mg/kg prednisone or adult equivalent over 4–14 days with or without taper. The NACIR captured treatment responses both retrospectively prior to enrollment and then prospectively, and both periods were included in this analysis. The multivariable logistic regression modeling process utilized SAS 9.1 using binary variables which were either significant in the univariate analysis or clinically important. A backwards elimination procedure was used to select the final model. Results: Seventy-six (13.8%) patients were treated with rituximab. Demographics of the patients treated with rituximab include: 42% male; 81% Caucasian, 17% Black, and 2% Asian. The mean age at diagnosis of ITP was 8.4 ± SD 5.1 years. The median platelet count at diagnosis of acute ITP was 10,000/uL (IQR 5,000-20,000/uL). 19 (25%) patients had secondary ITP or Evans syndrome. Treatment with rituximab had an overall response rate of 63.2% (48/76). Univariate predictors of response to rituximab are shown in Table I. The strongest univariate predictor of response to rituximab was response to steroids. Gender, ethnicity, and race were not predictive of response to rituximab. Furthermore, other variables which did not predict rituximab response include: history of a bleeding score ≥3 (Buchanan and Adix, J Pediatr 2002; 141: 683), symptoms ≥1 month prior to ITP diagnosis, older age (age >5 years), platelets ≥20,000/uL at acute ITP diagnosis, and a positive ANA. In multivariable analysis, response to steroids remained a strong predictor of response to rituximab with an OR 6.2 (95% CI 1.8–21.3, p=0.004). Secondary ITP also remained a strong a predictor of a positive response to rituximab with an OR 5.9 (95% CI 1.2–33.3, p=0.03). Conclusion: In the NACIR, response to steroids and secondary ITP were strong predictors of response to rituximab, a finding not previously reported in children or adults. Although this finding requires further validation, this result may provide evidence that rituximab should be most considered in patients previously responsive to steroids. Disclosures: Off Label Use: Rituximab for chronic ITP. Lambert:Cangene: Membership on an entity's Board of Directors or advisory committees. Klaassen:Novartis: Research Funding; Cangene: Research Funding. Neufeld:Novartis, Inc: Research Funding.

The naturally occurring macrotetrolide antibiotic nonactin is used in ammonium ion selective electrodes. To increase the lifetime of nonactin in the semipermeable membrane of these sensors we have developed methods for the introduction of hydrophobic side-chains. Simple model compounds for nonactic acid such as 5 and 7 were synthesised. Maintaining the cis arrangement of the substituents in the 2,5-disubstituted tetrahydrofurans proved to be difficult. Three different routes were studied. The enolates obtained by treatment with NaHMDS or KHMDS could be alkylated with benzyl or allyl iodide as electrophiles. Under these conditions a cis/trans isomerisation of the substituents on the tetrahydrofuran ring occurred. A multistep methodology was developed as a synthetic alternative. The sequence consisted of a selective retro-Michael reaction, a 5-exo-tet iodocyclisation and a radical substitution. The products obtained by the two methodologies could be correlated, and thereby a tentative assignment of the relative configurations could be achieved. In the third route the thione ester 18 was deprotonated with tBuOK. At temperatures below -78 °C, the enolate maintained the cis configuration of the substituents at the tetrahydrofuran ring. The alkylated product 12 could be isolated with a satisfactory cis/trans ratio of 85:15. The model compound 12 could be successfully transformed into more hydrophobic derivatives by using either the Heck coupling or the cross-coupling metathesis transformation.

Aus alt mach neu: Calixpyrrole sind bekannte Anionenbinder und konnen nur schwer in Ubergangsmetallkomplexe uberfuhrt werden. Die vollstandige Hydrierung eines Calixpyrrols ergab nun einen Liganden, der leicht klassische Kupfer-, Nickel- und Palladiumkomplexe bilden kann. Die Metallkomplexe enthalten ein Netzwerk von vier ausgerichteten Wasserstoffbrucken, die spezifisch Gegenionen binden (siehe Bild; blau N, weis H, grun Cl, rot Cu, Ni oder Pd).

New tricks for an old dog: Calixpyrroles bind anions efficiently and can be transformed into transition-metal complexes only under forcing conditions. Reducing the macrocycle creates a ligand that easily forms classical Werner complexes with copper, nickel, and palladium ions. The metal complexes present an array of four directed hydrogen bonds, which specifically bind the counterions (see picture; blue N, white H, green Cl, red Cu, Ni, or Pd).

Porphobilinogen synthase (PBGS) synthesizes porphobilinogen 2 (PBG), the common precursor of all natural tetrapyrroles, through an asymmetric condensation of two molecules of 5-aminolevulinic acid 1 (ALA). Symmetrically linked dimers 7-11 derived from levulinic acid 3 (gamma-oxovaleric acid) have been synthesized to mimic the assumed bisubstrate bound to the active site of the enzyme. Their inhibition potential was characterized by determination of the IC(50) and K(i) values using PBGS from Pseudomonas aeruginosa. The polarity and the size of the functional group linking the two levulinic acid 3 units have a strong influence on the inhibition behavior.

Studies on the preparation of pyrrolinone-based analogs of rhazinilam (VII) are presented, using suitably functionalized pyrrolinones, e.g. (VI), as key building blocks.

The structures of 5-aminolaevulinic acid dehydratase complexed with two irreversible inhibitors (4-oxosebacic acid and 4,7-dioxosebacic acid) have been solved at high resolution. Both inhibitors bind by forming a Schiff base link with Lys 263 at the active site. Previous inhibitor binding studies have defined the interactions made by only one of the two substrate moieties (P-side substrate) which bind to the enzyme during catalysis. The structures reported here provide an improved definition of the interactions made by both of the substrate molecules (A- and P-side substrates). The most intriguing result is the novel finding that 4,7-dioxosebacic acid forms a second Schiff base with the enzyme involving Lys 210. It has been known for many years that P-side substrate forms a Schiff base (with Lys 263) but until now there has been no evidence that binding of A-side substrate involves formation of a Schiff base with the enzyme. A catalytic mechanism involving substrate linked to the enzyme through Schiff bases at both the A- and P-sites is proposed.

Porphobilinogen synthase condenses two molecules of 5-aminolevulinate in an asymmetric way. This unusual transformation requires a selective recognition and differentiation between the substrates ending up in the A site or in the P site of porphobilinogen synthase. Studies of inhibitors based on the key intermediate first postulated by Jordan allowed differentiation of the two recognition sites. The P site, whose structure is known from X-ray crystallographic studies, tolerates ester functions well. The A site interacts very strongly with nitro groups, but is not very tolerant to ester functions. This differentiation is a central factor in the asymmetric handling of the two identical substrates. Finally, it could be shown that the keto group of the substrate bound at the A site is not only essential for the recognition, but that an increase in electrophilicity of the carbon atom also increases the inhibition potency considerably. This has important consequences for the recognition process at the A site, whose exact structure is not yet known.

We report the synthesis of N-benzyl-N-[(E)-buta-1,3-dienyl]propanamide (6) and its corresponding O-silyl-substituted ketene N,O-acetal 7 and their Diels-Alder reaction. Propanamide 6 reacted smoothly, whereas the yield obtained from 7 was low, probably due to polymerization of the dienophile induced by electron transfer. The ketene N,O-acetals 27a – g were synthesized starting from the corresponding benzamides 25a – e (Scheme 9). The ketene N,O-acetals 27a – g showed increased stabilities and underwent amino-Claisen rearrangements under thermal conditions. Using catalysts, interesting side reactions leading either to the annulated systems rac-35 – 37 or to a β-lactam rac-34 were observed.

The novel tandem process Diels-Alder reaction/Ireland-Claisen rearrangement shows a high diastereoselectivity for the Ireland-Claisen rearrangement starting from the endo-product of the Diels-Alder reaction. Based on this mechanistic knowledge, the novel tandem process could be applied to the synthesis of rac-juvabione.

A number of 2,3-epoxy alcohol derivatives (1–16), obtained either asracemates or through the Sharpless asymmetric epoxidation reaction, were studied ona Chiralcel OD column. Nearly all compounds exhibit good enantioselective resolutionon this chiral support. The order of elution of enantiomers is reversed between nerol andgeraniol compounds. For 2,3-epoxy alcohols bearing a remote alkoxy (or silyloxy) group,the order of the enantiomeric elution alternates with the number n (n = 1–3) of methy-lenic groups present between the epoxide ring and the terminal OR (R=p−BrBn orOSitBuPh 2 ) functionality. In the case of trans 2,3-epoxy alcohols for the same number n,the order of elution is reversed when changing the terminal group −OSi to −OR. Thelatter group greatly improves the separation of the two enantiomers. KEY WORDS: 2,3-epoxyalcohols; enantiomeric elution order; protective groups; chain length influenceFor the last decade, intense interest has focused on thedevelopment of synthetic methods leading to optically ac-tive synthons possessing a 1,2, 1,3, 1,2,3 polyhydroxylatedframe.

The elimination of thiocyanic acid from the stereoisomers of the hex-3-ene-2,5-diyl dithiocyanates, 4a, 4b, 6a and 6b, in the presence of a strong neutral base in an organic solvent, yields mixtures of the hex-2,4-dien-2-yl thiocyanates 9, 10 and 11via a preferentially syn process.

While attempting to synthesize a potential inhibitor of the biosynthetic step of formation of PBG, a novel catalytic system inducing the Prins reaction was discovered. Treatment of epoxy geranial with Zn and trimethylsilyl chloride gave (1S,2S,3R,6S) 3-Chloro-3-methyl-6-isopropenyl-1,2-cyclohexanediol in high diastereoselectivity.

To obtain stable derivatives of α-unsubstituted pyrroles, the reaction of the test pyrrole 9 with a series of chalcones 14a–h were studied. Michael adducts 16b–h could be isolated. In order to synthesize coloured derivatives, the reaction of different pyrroles 9, 21, 23, and 25 with diphenylpropynone 19 was investigated. In these cases, too, Michael-addition products were formed. The intense absorption band around 400 nm makes the identification of these derivatives easy.

1-Methoxycarbonyl-Substituted 2,3-Dihydropyridin-4(1H)-one(= Methyl 1,2,3,4-Tetrahydro-4-oxopyridine-1-carboxylate) as Chromophore for Photochemical [2 + 2]-Cycloadditions With olefins having an electron-acceptor as well as with olefins having an electron-donor substituent, 1-methoxycarbonyl-substituted dihydropyridinone 12 undergoes [2 + 2] cycloaddition in good preparative yields. The photochemical cycloaddition is highly regioselective. For preparative purposes, the ring junction can be equilibrated to the thermodynamically more stable cis-junction. Only the ‘endo’/‘exo’ selectivity at the C-atom bearing the olefin substituent cannot be controlled. The photodimerization of 12 is the only side reaction. Using a slight excess of the olefin, the photodimerization can be suppressed. The protecting group at the N-atom of the dihydropyridinone can be varied in order to introduce an internal sensitizer, as shown with 1-acyl-substituted compound 29, which underwent the cycloaddition process even with sunlight.