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In the first phase 3 study in relapsed/refractory AL amyloidosis (TOURMALINE-AL1 NCT01659658), 168 patients with relapsed/refractory AL amyloidosis after 1–2 prior lines were randomized to ixazomib (4 mg, days 1, 8, 15) plus dexamethasone (20 mg, days 1, 8, 15, 22; n = 85) or physician’s choice (dexamethasone ± melphalan, cyclophosphamide, thalidomide, or lenalidomide; n = 83) in 28-day cycles until progression or toxicity. Primary endpoints were hematologic response rate and 2-year vital organ deterioration or mortality rate. Only the first primary endpoint was formally tested at this interim analysis. Best hematologic response rate was 53% with ixazomib–dexamethasone vs 51% with physician’s choice (p = 0.76). Complete response rate was 26 vs 18% (p = 0.22). Median time to vital organ deterioration or mortality was 34.8 vs 26.1 months (hazard ratio 0.53; 95% CI, 0.32–0.87; p = 0.01). Median treatment duration was 11.7 vs 5.0 months. Adverse events of clinical importance included diarrhea (34 vs 30%), rash (33 vs 20%), cardiac arrhythmias (26 vs 15%), nausea (24 vs 14%). Despite not meeting the first primary endpoint, all time-to-event data favored ixazomib–dexamethasone. These results are clinically relevant to this relapsed/refractory patient population with no approved treatment options.

Triboelectrostatic separation is a promising technology for the fractionation of agricultural flours to produce protein- and starch-enriched fractions. Rapid determination of the protein and starch content of these powder fractions is required for process development, optimization and ultimately control. The suitability of near-infrared and fluorescence spectroscopy along with data fusion for the rapid determination of protein and starch content and the development of a robust multivariate regression model was the objective in this work. A total of 102 samples were collected following triboelectrostatic separation of bean flour and analyzed using NIR and fluorescence spectroscopy. The superior performance of partial least squares method for both protein and starch, confirmed that NIR spectroscopy is a reliable method for rapid determination of protein- and starch-rich powders. The NIR and fluorescence data fusion model performed with the highest accuracy to predict the protein content.

Cycloalkanes and alkenes are important components of real fuels but there is little kinetic and mechanistic data on the dissociation of most large cyclic and olefinic molecules at elevated temperatures. We present here the first experimental and theoretical investigation of dissociation of cycloheptane and the initial product from ring opening, 1-heptene. Experiments were performed in a diaphragmless shock tube using laser schlieren densitometry. Pyrolysis of cycloheptane (0.5–4% in Kr) was studied over 1450–2000 K and 30–120 Torr. Experiments with 1-heptene (1–4% in Kr) covered 1200–1650 K and 30–120 Torr. A newly developed chemical kinetic mechanism for pyrolysis of cycloheptane and 1-heptene is presented herein. Simulations are in very good agreement with the experimental measurements. Rate coefficients for the initial ring-opening process in cycloheptane, k1, and dissociation of 1-heptene, k2, were determined from the experiments. Both k1 and k2 are in falloff, and the pressure and temperature dependencies were well reproduced by theoretical calculations allowing extrapolation to conditions beyond the scope of this work. These calculations yielded the following expressions for k1 and k2 with the uncertainties estimated as ±40% and ±50% respectively: k 1 , ∞ = 5.94 × 10 17 exp ( − 44 , 521 T ) s − 1 and k 2 , ∞ = 8.86 × 10 16 exp ( − 35 , 887 T ) s − 1 . The results of this study indicate that cycloheptane dissociates similarly to cyclopentane and cyclohexane, i.e. ring-opening via C C scission to a diradical that rapidly isomerizes to a conjugate 1-alkene. The secondary chemistry is dominated by the dissociation products of the 1-alkenes i.e. allyl and n-alkyl radicals. Furthermore, rates of dissociation of the cycloalkanes are size dependent and kcyclopentane

The effect of hammer milling on the efficiency of a triboelectrostatic separation process to produce protein-, starch-, and seed-coat fibrous- enriched fractions from navy bean flour was investigated and the results were compared with previously published data for pin milled flour. Results revealed that samples collected from the middle and top part of the plate had significantly higher protein content and therefore lower starch content than the samples collected from the bottom of the plate. The bin that was located on the bottom of the separator, directly below the entrance of the ejector nozzle, contained higher amounts of seed-coat fibrous particles. A maximum protein content of 39.3 ± 0.7% and 32.6 ± 0.1% occurred on the middle/top and bottom part of the plate for optimum operating conditions. Hammer milling yielded a larger average particle size and a lower triboelectric separation efficiency compared to pin milling.

BACKGROUND: Approaches to risk assessment in pulmonary arterial hypertension (PAH) include the noninvasive French risk assessment approach (number of low-risk criteria based on the European Society of Cardiology and European Respiratory Society guidelines) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) 2.0 risk calculator. The prognostic and predictive value of these methods for morbidity/mortality was evaluated in the predominantly prevalent population of GRIPHON, the largest randomized controlled trial in PAH. METHODS: GRIPHON randomized 1,156 patients with PAH to selexipag or placebo. Post-hoc analyses were performed on the primary composite end-point of morbidity/mortality by the number of low-risk criteria (World Health Organization functional class I-II; 6-minute walk distance >440 m; N-terminal pro-brain natriuretic peptide

CD148 is a transmembrane protein tyrosine phosphatase (PTP) that is expressed in the renal vasculature, including the glomerulus. Previous studies have shown that CD148 plays a role in the negative regulation of growth factor signals (including epidermal growth factor and vascular endothelial growth factor), suppressing cell proliferation and transformation. However, the role of CD148 in kidney disease remains unknown. Here, we generated an agonistic anti-CD148 antibody and evaluated its effects in murine diabetic nephropathy (DN). Monoclonal antibodies (mAbs) against the mouse CD148 ectodomain sequence were generated by immunizing CD148 knockout (CD148KO) mice. The mAbs that increased CD148 activity were selected by biological (proliferation) and biochemical (PTP activity) assays. The mAb (18E1) that showed strong agonistic activity was injected (10 mg/kg ip) in streptozotocin-induced wild-type and CD148KO diabetic mice for 6 wk, and the renal phenotype was then assessed. The effects of 18E1 mAb in podocyte growth factor signals were also assessed in culture. Compared with control IgG, 18E1 mAb significantly decreased albuminuria and mesangial expansion without altering hyperglycemia and blood pressure in wild-type diabetic mice. Immunohistochemical evaluation showed that 18E1 mAb significantly prevented the reduction of podocyte number and nephrin expression and decreased glomerular fibronectin expression and renal macrophage infiltration. The 18E1 mAb showed no effects in CD148KO diabetic mice. Furthermore, we demonstrated that 18E1 mAb reduces podocyte epidermal growth factor receptor signals in culture and in diabetic mice. These findings suggest that agonistic anti-CD148 mAb attenuates DN in mice, in part by reducing epidermal growth factor receptor signals in podocytes. This antibody may be used for the treatment of early DN.

Hyperactivation of cyclin-dependent kinase 5 (CDK5) by p25, contributes to neuroinflammation causing neurodegeneration in Parkinson’s Disease (PD) and Alzheimer diseases (AD). However, the mechanism by which CDK5 induces neuroinflammation in the PD brain is largely unexplored. Here, we show that CDK5 phosphorylates cytosolic phospholipase A2 (cPLA2) at Thr-268 and Ser-505 sites lead to its activation and generation of eicosanoid products. Mutational studies using site-directed mutagenesis and molecular simulations show that the architecture of the protein changes upon each single-point mutation. Interestingly, double-mutations also led to severe decline in the activity of cPLA2 and disruption of its translocation to the plasma membrane. Further, the brain lysates of transgenic PD mouse models show hyperactivation of CDK5 resulting in enhanced phosphorylation of Thr-268 and Ser-505 of cPLA2 and its heightened activity confirming the findings observed in the cell culture model of PD. These phosphorylation sites of cPLA2 and CDK5 could be explored as the future therapeutic targets against neuroinflammation in PD. Further, conjoint transcriptomic analysis of the publicly available human PD datasets strengthens the hypothesis that genes of the arachidonic acid, prostaglandin synthesis and inflammatory pathways are significantly upregulated in case of the PD patients as compared to that of healthy controls.

Background In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies. Methods Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters. Results At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively. Conclusions In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.

The hot refractory anode vacuum arc (HRAVA) plasma source was previously developed with a consumed cathode and a refractory anode to reduce the macroparticle (MP) contamination in vacuum arc deposited films. The HRAVA had open cylindrical electrodes and demonstrated that it not only reduced MP sizes and numbers but also converted MP material to plasma, and thus increased the deposition rate. This paper presents a new HRAVA configuration with a double arc between a common water-cooled Cu cathode with two active surfaces and two refractory graphite or tungsten anodes, with the aim of depositing film over a wider area. The arc current in each of the two arcs was 125 A for graphite and 150 A for tungsten. The radially expanding plasma plumes from each of the cathode–anode gaps merged, forming a wider common plasma. Cu films were deposited and over a 150 mm length parallel to the arc axis, while the corresponding length from a single-HRAVA source was only 75 mm.

A primary driver of the wheat yield gap in Australia and globally is the supply of nitrogen (N) and options to increase N use efficiency (NUE) are fundamental to closure of the yield gap. Co‐application of N with phosphorus (P) is suggested as an avenue to increase fertiliser NUE, and inputs of N and P fertiliser are key variable costs in low rainfall cereal crops. Within field variability in the response to nutrients due to soil and season offers a further opportunity to refine inputs for increased efficiency. The response of wheat to N fertiliser input (0, 10, 20, 40 and 80 kg N ha‐1) under four levels of P fertiliser (0, 5, 10 and 20 kg P ha−1) was measured on three key low rainfall cropping soils (dune, mid‐slope and swale) across a dune‐swale system in a low rainfall semi‐arid environment in South Australia, for three successive cropping seasons. Wheat on sandy soils produced significant and linear yield and protein responses across all three seasons, while wheat on a clay loam only produced a yield response in a high rainfall season. Responses to P fertiliser were measured on the sandy soils but more variable in nature and a consistent effect of increased P nutrition leading to increased NUE was not measured.

A sustainable, chemical-free dry tribo-electrostatic separation approach was employed to fractionate navy bean flour. The resulting protein-enriched fractions had 36–38% protein on a moisture free basis, accounting for 43% of the total available protein. SDS-PAGE analysis of the dry-enriched protein fractions showed a similar protein profile to that of the original navy bean flour. The functional properties of these fractions were examined and compared with the commercial soybean protein concentrate as well as navy bean protein isolate obtained by a conventional wet fractionation process. These electrostatically separated protein fractions exhibited superior solubility at their intrinsic pH as well as superior emulsion stability (ES), foam expansion (FE) and foam volume stability (FVS) compared to the wet-fractionated navy bean protein isolate that was almost depleted of albumins, exhibiting poor solubility and foaming properties. These results suggest electrostatic separation as a promising route to deliver functional protein concentrates as novel food formulation ingredients.

Background Conventional methods for extraction of plant protein, starch and fiber use solvents and intensive drying. These processes are energy intensive and can alter the native structure and function of isolates. Dry fractionation methods have been investigated as solvent-free means for the production of protein-, starch- and fiber-enriched products. Two widely studied methods for dry fractionation of plant flours are air classification and electrostatic separation. Scope and approach Several aspects of both air classification and electrostatic separation are reviewed: basic operating principles; the effect of milling conditions; physical factors that influence separation efficiency; isolate structure and function; and advantages and disadvantages with respect to traditional wet processes. Quantitative approaches in the design and analysis of dry fractionation are also reviewed, in addition to recent patent developments and future prospects of the technology. Key findings and conclusions Dry fractionation methods exhibit lower energy and water consumption relative to wet extraction and retain native structure and function of components. However, these technologies are not yet suitable for the production of high-purity isolates (>90%). Physical limitations of these technologies, such as powder fouling and low process yield, may pose problems for commercialization. Increases in product concentration have been achieved by recycling fractions and by combining different separation techniques in series, such as air classification followed by electrostatic separation. Recent patents show a trend in the development of technologies that integrate elements of milling, sieving, air classification and electrostatic separation.

Resistance to extinction by stretch and and laminar flame speed are important properties of any combustible mixture. Recent work has shown that extinction by stretch controls the overall structure of several important types of methane-based turbulent flames. The parameter used to quantify this phenomena, Extinction Strain Rate (ESR), is numerically studied here for methane-based flames across a range of pressures relevant to gas turbines and internal combustion engines, 1-40 atm. The pressure trends are compared with those of laminar flame speed which is historically better studied. Current kinetic models agree that ESR of lean flames is a non-monotonic function of pressure and that ESR of rich flames increases significantly with pressure, but are found to differ significantly in their numerical predictions of ESR, particularly at higher pressures. To better identify the source of model prediction differences and what governs the overall accuracy of the ESR predictions, various model sensitivity analyses were conducted. Pressure-dependent kinetics are shown to be vital to determining ESR pressure trends as are molecular collision efficiencies. Yet, reactions sensitivities for ESR largely mirror those for laminar flame speed calculations. Sensitivity to the transport parameter, Lennard Jones diameter, significantly exceeds reaction sensitivities for the fuel, oxidizer and bath gas. Thermodynamic parameter ESR sensitivities vary widely with pressure, but at least for enthalpy, appear insignificant when uncertainties are considered. This study informs and motivates further efforts to understand the phenomena of flame extinction by stretch at elevated pressures.

Both agonist studies and loss-of-function models indicate that PPARγ plays an important role in cutaneous biology. Since PPARγ has a high level of basal activity, we hypothesized that epidermal PPARγ would regulate normal homeostatic processes within the epidermis. In this current study, we performed mRNA sequencing and differential expression analysis of epidermal scrapings from knockout mice and wildtype littermates. Pparg-/-epi mice exhibited a 1.5-fold or greater change in the expression of 11.8% of 14,482 identified transcripts. Up-regulated transcripts included those for a large number of cytokines/chemokines and their receptors, as well as genes associated with inflammasome activation and keratinization. Several of the most dramatically up-regulated pro-inflammatory genes in Pparg-/-epi mouse skin included Igfl3, 2610528A11Rik, and Il1f6. RT-PCR was performed from RNA obtained from non-lesional full-thickness skin and verified a marked increase in these transcripts, as well as transcripts for Igflr1, which encodes the receptor for Igfl3, and the 2610528A11Rik receptor (Gpr15). Transcripts for Il4 were detected in Pparg-/-epi mouse skin, but transcripts for Il17 and Il22 were not detected. Down-regulated transcripts included sebaceous gland markers and a number of genes associated with lipid barrier formation. The change in these transcripts correlates with an asebia phenotype, increased transepidermal water loss, alopecia, dandruff, and the appearance of spontaneous inflammatory skin lesions. Histologically, non-lesional skin showed hyperkeratosis, while inflammatory lesions were characterized by dermal inflammation and epidermal acanthosis, spongiosis, and parakeratosis. In conclusion, loss of epidermal Pparg alters a substantial set of genes that are associated with cutaneous inflammation, keratinization, and sebaceous gland function. The data indicate that epidermal PPARγ plays an important role in homeostatic epidermal function, particularly epidermal differentiation, barrier function, sebaceous gland development and function, and inflammatory signaling.

BackgroundChimeric antigen receptor T-cell (CAR-T) infusion is associated with early toxicity. Yet, whether early toxicity development holds ramifications for long-term outcomes is unknown.MethodsFrom a large cohort of consecutive adult patients treated with CAR-T therapies for relapsed or refractory lymphomas from 2016 to 2019, we assessed progression-free survival (PFS), by toxicity development (cytokine release syndrome (CRS), neurotoxicity, or cardiotoxicity]. We also assessed the relationship of toxicity development to objective disease response, and overall survival (OS). Multivariable regression was utilized to evaluate relationships between standard clinical and laboratory measures and disease outcomes. Differences in outcomes, by toxicity status, were also assessed via 30-day landmark analysis. Furthermore, we assessed the effects of early anti-CRS toxicity therapy use (at ≤grade 2 toxicity) on maximum toxicity grade observed, and long-term disease outcomes (PFS and OS).ResultsOverall, from 102 CAR-T-treated patients, 90 were identified as treated with single-agent therapy, of which 88.9% developed toxicity (80 CRS, 41 neurotoxicity, and 17 cardiotoxicity), including 28.9% with high-grade (≥3) events. The most common manifestations were hypotension at 96.6% and fever at 94.8%. Among patients with cardiac events, there was a non-significant trend toward a higher prevalence of concurrent or preceding high-grade (≥3) CRS. 50.0% required tocilizumab or corticosteroids. The median time to toxicity was 3 days; high grade CRS development was associated with cardiac and neurotoxicity. In multivariable regression, accounting for disease severity and traditional predictors of disease response, moderate (maximum grade 2) CRS development was associated with higher complete response at 1 year (HR: 2.34; p=0.07), and longer PFS (HR: 0.41; p=0.02, in landmark analysis), and OS (HR: 0.43; p=0.03). Among those with CRS, relative blood pressure (HR: 2.25; p=0.004), respectively, also associated with improved PFS. There was no difference in disease outcomes, or maximum toxicity grade (CRS, neurotoxicity, or cardiotoxicity) observed, based on the presence or absence of the use of early CRS-directed therapies.ConclusionsAmong adult lymphoma patients, moderate toxicity manifest as grade 2 CRS after CAR-T infusion may associate with favorable clinical outcomes. Further studies are needed to confirm these findings.

Isolevuglandins (IsoLGs) are highly reactive gamma ketoaldehydes formed from H2-isoprostanes through lipid peroxidation and crosslink proteins leading to inflammation and various diseases including hypertension. Detection of IsoLG accumulation in tissues is crucial in shedding light on their involvement in the disease processes. However, measurement of IsoLGs in tissues is extremely difficult, and currently available tools, including mass spectrometry analysis, are laborious and extremely expensive. Here we describe a novel method for in situ detection of IsoLGs in tissues using alkaline phosphatase-conjugated D11 ScFv and a recombinant phage-display antibody produced in E. coli by immunofluorescent microscopy. Four controls were used for validating the staining: (1) staining with and without D11, (2) staining with bacterial periplasmic extract with the alkaline phosphatase linker, (3) irrelevant scFV antibody staining, and (4) competitive control with IsoLG prior to the staining. We demonstrate the effectiveness of the alkaline phosphatase-conjugated D11 in both human and mouse tissues with or without hypertension. This method will likely serve as an important tool to study the role of IsoLGs in a wide variety of disease processes.

BACKGROUND: Riociguat and phosphodiesterase-5 inhibitors (PDE5i), approved for the treatment of pulmonary arterial hypertension (PAH), act on the same pathway via different mechanisms. Riociguat might be an alternative option for patients with PAH who do not respond sufficiently to treatment with PDE5i, but comparisons of the potential benefits of riociguat and PDE5i in these patients are needed. The aim of this trial was to assess the effects of switching to riociguat from PDE5i therapy versus continued PDE5i therapy in patients with PAH at intermediate risk of 1-year mortality.METHODS: Riociguat rEplacing PDE5i therapy evaLuated Against Continued PDE5i thErapy (REPLACE) was an open-label, randomised controlled trial in 81 hospital-based pulmonary hypertension centres in 22 countries. The study enrolled patients aged 18-75 years with symptomatic PAH at intermediate risk of 1-year mortality (based on the European Society for Cardiology-European Respiratory Society guideline thresholds for WHO functional class and 6-min walk distance [6MWD]) who were receiving treatment with a PDE5i with or without an endothelin receptor antagonist for at least 6 weeks before randomisation. Patients were excluded if they had been previously treated with riociguat, had used prostacyclin analogues or prostacyclin receptor agonists within 30 days before randomisation, had clinically significant restrictive or obstructive parenchymal lung disease, or had left heart disease. Patients were randomly assigned (1:1) to remain on PDE5i treatment (oral sildenafil [≥60 mg per day] or oral tadalafil [20-40 mg per day]; the PDE5i group) or to switch to oral riociguat (up to 2·5 mg three times per day; the riociguat group), using an interactive voice and web response system, stratified by cause of PAH. The primary endpoint was clinical improvement by week 24, defined as an absence of clinical worsening and prespecified improvements in at least two of three variables (6MWD, WHO functional class, and N-terminal prohormone of brain natriuretic peptide), analysed using last observation carried forward in all randomly assigned patients with observed values at baseline and week 24 who received at least one dose of study medication (the full analysis set). Secondary endpoints included clinical worsening events. The trial has been completed and is registered with ClinicalTrials.gov, NCT02891850.FINDINGS: Between Jan 11, 2017, and July 31, 2019, 293 patients were screened, of which 226 patients were randomly assigned to the riociguat group (n=111) or to the PDE5i group (n=115). 211 patients completed the study and 14 patients discontinued (seven in each group). One patient assigned to the PDE5i group did not receive treatment, so 225 patients were included in the safety analysis, and one further patient in the PDE5i group had missing components of the composite primary endpoint at baseline, so 224 patients were included in the full analysis set. The primary endpoint was met by 45 (41%) of 111 patients in the riociguat group and 23 (20%) of 113 patients in the PDE5i group; odds ratio [OR] 2·78 (95% CI 1·53-5·06; p=0·0007). Clinical worsening events occurred in one (1%) of 111 patients in the riociguat group (hospitalisation due to worsening PAH) and 10 (9%) of 114 patients in the PDE5i group (hospitalisation due to worsening PAH [n=9]; disease progression [n=1]; OR 0·10 [0·01-0·73]; p=0·0047). The most frequently occurring adverse events were hypotension (15 [14%]), headache (14 [13%]), and dyspepsia (10 [9%]) in the riociguat group, and headache (eight [7%]), cough (seven [6%]), and upper respiratory tract infection (seven [6%]) in the PDE5i group. Serious adverse events were reported in eight (7%) of 111 patients in the riociguat group and 19 (17%) of 114 patients in the PDE5i group. During the study, four patients died in the PDE5i group, one of them during the safety follow-up period.INTERPRETATION: Switching to riociguat from PDE5i treatment, both of which act via the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate pathway, could be a strategic option for treatment escalation in patients with PAH at intermediate risk of 1-year mortality.FUNDING: Bayer AG, Merck Sharp & Dohme.

COVID-19–related lockdowns led to significant reductions in NO2 globally, but not in fine particulates and ozone., Responses to the COVID-19 outbreak resulted in one of the largest short-term decreases in anthropogenic emissions in modern history. To date, there has been no comprehensive assessment of the impact of lockdowns on air quality and human health. Using global satellite observations and ground measurements from 36 countries in Europe, North America, and East Asia, we find that lockdowns led to reductions in NO2 concentrations globally, resulting in ~32,000 avoided premature mortalities, including ~21,000 in China. However, we do not find corresponding reductions in PM2.5 and ozone globally. Using satellite measurements, we show that the disconnect between NO2 and ozone changes stems from local chemical regimes. The COVID-related lockdowns demonstrate the need for targeted air quality policies to reduce the global burden of air pollution, especially related to secondary pollutants.

Kidney transplant (KT) outcomes from high kidney donor profile index (KDPI ≥85%) donors with acute kidney injury (AKI) remain underreported. KT from 172 high KDPI Acute Kidney Injury Network (AKIN) stage 0-1 donors and 76 high KDPI AKIN stage 2-3 donors from a single center were retrospectively assessed. The AKIN 2-3 cohort had more delayed graft function (71% vs. 37%, p

Regulatory B cells (Bregs) contribute to immune regulation. However, the mechanisms of action of Bregs remain elusive. Here, we report that T cell immunoreceptor with Ig and ITIM domains (TIGIT) expressed on human memory B cells especially CD19+CD24hiCD27+CD39hiIgD−IgM+CD1c+ B cells is essential for effective immune regulation. Mechanistically, TIGIT on memory B cells controls immune response by directly acting on T cells and by arresting proinflammatory function of dendritic cells, resulting in the suppression of Th1, Th2, Th17, and CXCR5+ICOS+ T cell response while promoting immune regulatory function of T cells. TIGIT+ memory B cells are also superior to other B cells at expressing additional inhibitory molecules, including IL-10, TGFβ1, granzyme B, PD-L1, CD39/CD73, and TIM-1. Lack or decrease of TIGIT+ memory B cells is associated with increased donor-specific antibody and TFH response, and decreased Treg response in renal and liver allograft patients. Therefore, TIGIT+ human memory B cells play critical roles in immune regulation., Regulatory B cells have been shown to play critical roles in the modulation of the immune system. Here, the authors implicate TIGIT expression in B cells with the process of immuno-regulation.

This chapter presents aircraft-based methods of measuring the flux densities of sensible and latent heat, carbon dioxide, ozone, nitrous oxide, methane, and other trace gases. The main techniques and sensors that are used to measure flux densities with an aircraft are briefly described. Factors that affect the accuracy of those flux density measurements are discussed, including analysis techniques, run lengths, sampling heights, surface and environmental conditions, and data quality assessment. The use of aircraft-based flux density measurements to evaluate the representativeness of tower-based flux measurements is examined. The versatility of aircraft to act as sensor platforms under a wide range of conditions is demonstrated using several interesting examples. Future potential research directions are mentioned., Series: Springer Handbooks

The combination of bosentan and sildenafil is commonly used to treat patients with pulmonary arterial hypertension (PAH); however, there is evidence of a significant drug interaction between these two medications. We sought to evaluate the safety and efficacy of transitioning patients with PAH from the combination of bosentan and sildenafil to alternative therapy. A retrospective database review was performed on 16 patients with PAH who were treated with the combination of bosentan and sildenafil and transitioned to alternative treatment at our center. Invasive and non-invasive patient parameters were collected at baseline and after transition. 56.3% of patients were in World Health Organization functional class (WHO FC) III and a majority of patients (68.7%) were on background prostacyclin therapy. The most common reason for transition was concern for a drug interaction in seven patients (43.8%). The most common transition was bosentan to macitentan in eight patients (50%). Fifteen patients (93.8%) tolerated the transition after a median follow-up of 6.5 months with minor adverse events occurring in four patients (25%). In 11 patients, 6-min walk distance (6MWD) was unchanged comparing baseline to post transition measurements with a median change of +8 m (range: −50 to + 70; P = 0.39). Nine patients (81.8%) had stable (within 15% margin) or significant improvement (increase by ≥15%) in 6MWD after transition. All patients demonstrated stable or improved WHO FC after transition. There were no significant changes after transition in hemodynamics, N-terminal pro-brain natriuretic peptide (NT-proBNP) values, or Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk scores. In our study, transitioning patients from bosentan and sildenafil to alternative therapy was safe and resulted in clinical stability.

Limited evidence is available on outcomes associated with currently available medications from the endothelin receptor antagonist drug class (bosentan, ambrisentan, and macitentan) in elderly patients with pulmonary arterial hypertension. We evaluated mortality in predominantly elderly patients with pulmonary arterial hypertension in the US taking endothelin receptor antagonists. A retrospective administrative claims study was conducted using the Centers for Medicare and Medicaid Services national Medicare database. Patients with pulmonary arterial hypertension were identified using diagnostic codes. Cohort inclusion required age ≥18 years; ≥1 claim for macitentan, ambrisentan, or bosentan between 1 January 2014 and 31 December 2015 (index date and index endothelin receptor antagonist defined by first such claim); continuous enrollment for ≥12 months before and after the index date; and ≥80% of days covered for the index endothelin receptor antagonist. Follow-up was from index date until the earliest of Medicare disenrollment, death, or 31 December 2016. Multivariable Cox proportional hazards regression models were used to estimate mortality hazard ratios with 95% confidence intervals for macitentan vs. ambrisentan or bosentan, adjusting for potential confounders. The study cohort included 1628 patients on index macitentan, 2852 on ambrisentan, and 1972 on bosentan. Overall, 69% of patients were aged ≥65 years and most were females (76%). Macitentan was associated with an 18% lower risk for mortality than ambrisentan (hazard ratio: 0.82, 95% confidence interval: 0.72–0.93; P = 0.0026) and a 39% lower risk than bosentan (hazard ratio: 0.61, 95% confidence interval: 0.53–0.71; P

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary vascular resistance that can lead to right ventricular failure and death. The use of medications that affect the prostacyclin pathway is an important treatment strategy in PAH. Inhaled iloprost is a prostacyclin analogue, and selexipag is an oral, non-prostanoid, prostacyclin IP receptor agonist. Data are limited on transitioning patients from inhaled iloprost to selexipag. In this case report, we describe the successful transition of a 57-year-old female with heritable PAH from inhaled iloprost to selexipag over 8 weeks in an out-patient setting. After initiation of selexipag, the patient’s inhaled iloprost dose was gradually reduced and eventually discontinued. The patient tolerated the transition well with stable symptoms, 6-minute walk distance, and pulmonary hemodynamics. Additional studies are needed to better define the comparative efficacy and safety of inhaled iloprost and selexipag.

Introduction The manufacturing labels for all currently marketed gadolinium-based MRI contrast agents describe adverse cardiac events reported during post-market use. The goal of this study was to determine prolongation of the rate-corrected QT interval occurs in the immediate setting after gadolinium-based MRI contrast agent injection. Methods This study enrolled adults scheduled to have a gadolinium-based MRI contrast agent injection as part of a diagnostic MRI. A single-lead electrocardiogram was recorded using the AliveCor Kardia® ECG (Mountain View, CA) device before and after injection. The rate-corrected QT interval was subsequently measured by two independent investigators. The QT interval was corrected for rate using the two most common formulas, originally cited by Bazett and Fridericia. These rate-corrected QT intervals from before and after gadolinium-based MRI contrast agent injection were compared using the Wilcoxon signed-rank test paired analysis. Results A total of 24 consenting adults had electrocardiogram that were free of motion artifact. The mean age of the final patient cohort was 59.4 years. There was an equal split of 12 men and 12 women. The mean pre-injection, rate-corrected QT interval, corrected using Bazett's formula, was 395 msec. The mean post-injection, rate-corrected QT interval, corrected using Bazett's formula, was 396 msec. The corrections using Fridericia's formula were 384 and 381 msec, respectively. There was no statistically significant change in Bazett-corrected QT interval (QTc-B) when pre-injection and post-injection values were directly compared. Discussion The results of the present investigation support the conclusion that gadolinium-based MRI contrast agents do not commonly affect rate-corrected QT interval in routine clinical use. While the frequency of rate-corrected QT interval prolongation might be overstated, the severity of adverse events is definitively not. A role for concomitant rate-corrected QT interval-prolonging drugs or unidentified rare factors such as genetic predisposition cannot be ruled out. The limitations of this study include its relatively small size and the implementation of a single-lead electrocardiogram to measure rate-corrected QT interval. Conclusion The present investigation revealed that significant rate-corrected QT interval prolongation, while previously reported in as many as 55% of patients after gadolinium-based MRI contrast agent injection, is not a common occurrence in the routine clinical setting.

Venetoclax is efficacious in relapsed/refractory t(11;14) multiple myeloma, thus warranting investigation in light-chain amyloidosis (AL). This retrospective cohort includes 43 patients with previously treated AL, from 14 centers in the US and Europe. Thirty-one patients harbored t(11;14), 11 did not, and one t(11;14) status was unknown. Patients received a venetoclax-containing regimen for at least one 21- or 28-day cycle; the median prior treatments was three. The hematologic response rate for all patients was 68%; 63% achieved VGPR/CR. t(11;14) patients had higher hematologic response (81% vs. 40%) and higher VGPR/CR rate (78% vs. 30%, odds ratio: 0.12, 95% CI 0.02–0.62) than non-t(11;14) patients. For the unsegregated cohort, median progression-free survival (PFS) was 31.0 months and median OS was not reached (NR). For t(11;14), median PFS was NR and for non-t(11;14) median PFS was 6.7 months (HR: 0.14, 95% CI 0.04–0.53). Multivariate analysis incorporating age, sex, prior lines of therapy, and disease stage suggested a risk reduction for progression or death in t(11;14) patients. Median OS was NR for either subgroup. The organ response rate was 38%; most responders harbored t(11;14). Grade 3 or higher adverse events occurred in 19% with 7% due to infections. These promising results require confirmation in a randomized clinical trial.

Enzyme-catalyzed chemical reactions produce heat. We developed an enclosed, capillary-perfused nanocalorimeter platform for thermometric enzyme-linked immunosorbent assay (TELISA). We used catalase as enzymes to model the thermal characteristics of the micromachined calorimeter. Model-assisted signal analysis was used to calibrate the nanocalorimeter and to determine reagent diffusion, enzyme kinetics, and enzyme concentration. The model-simulated signal closely followed the experimental signal after selecting for the enzyme turnover rate (kcat) and the inactivation factor (InF), using a known label enzyme amount (Ea). Over four discrete runs (n = 4), the minimized model root mean square error (RMSE) returned 1.80 &plusmn, 0.54 fmol for the 1.5 fmol experiments, and 1.04 &plusmn, 0.37 fmol for the 1 fmol experiments. Determination of enzyme parameters through calibration is a necessary step to track changing enzyme kinetic characteristics and improves on previous methods to determine label enzyme amounts on the calorimeter platform. The results obtained using model-system signal analysis for calibration led to significantly improved nanocalorimeter platform performance.

Butyrylcholinesterase (BChE) is a glycosylated serine hydrolase found in human serum that has been shown to protect against various cholinesterase-inhibiting organophosphate nerve agents. The supply of plasma-derived butyrylcholinesterase (hBChE) is constrained by the availability of human blood and a complex purification process and its high cost. This constraints necessitates the development of expression platforms capable of large-scale, low-cost production of an active recombinant BChE (rBChE). Traditionally, procainamide affinity chromatography has been used to purify BChE. Recently, an effective affinity chromatography resin based on a potent cholinesterase inhibitor (tacrine-huperzine A hybrid; huperine X termed as Hupresin®) was developed. Here, we describe a purification scheme of rBChE from Nicotiana benthamiana plants. Different extraction buffers were screened for their ability to extract rBChE and native plant proteins. Citrate buffer at pH 4 was selected to minimize extraction of host plant proteins and showed a 4.5-fold enhancement in rBChE specific activity compared to Tris buffer, pH 8. DEAE-Sepharose chromatography increased the purity of rBChE by 70% by removing major host plant protein impurities. The rBChE was then adsorbed to Hupresin® and purified to homogeneity for an overall process yield of 34%. The purification process represents a threefold higher product yield over the established process. Mass spectrometry confirmed the protein sequence and site-specific N-glycosylation analysis was performed.

Microorganisms used in syngas fermentation require nutrients to grow and convert syngas (CO, H2 and CO2) into various products. Many of the essential nutrients can be provided by biochar. Poultry litter biochar (PLBC) contains minerals and trace metals and has a high pH buffering capacity, making it suitable as a nutrient supplement. The effects of PLBC loadings from 1 to 20 g L−1 on syngas fermentation were determined in 250 ml bottle assays. Results showed that 10 and 20 g L−1 PLBC significantly increased ethanol production compared to standard yeast extract (YE) medium. Fermentations in a 3L continuous stirred tank reactor (CSTR) with 10 g L−1 PLBC with and without 4-morpholineethanesulfonic acid (MES) showed 64% and 36% more ethanol production, respectively, than standard medium. The acetic acid accumulated at the beginning of fermentation was completely converted to ethanol in all media tested in the CSTR. These results demonstrate the feasibility of using PLBC medium without costly MES in the CSTR to enhance ethanol production from syngas for potential use at commercial scale.

Naturally occurring dietary agents present in a wide variety of plant products, are rich sources of phytochemicals possessing medicinal properties, and thus, have been used in folk medicine for ages to treat various ailments. The beneficial effects of such dietary components are frequently attributed to their anti-inflammatory and antioxidant properties, particularly in regards to their antineoplastic activities. As many tumor types exhibit greater oxidative stress levels that are implicated in favoring autonomous cell growth activation, most chemotherapeutic agents can also enhance tumoral oxidative stress levels in part via generating reactive oxygen species (ROS). While ROS-mediated imbalance of the cellular redox potential can provide novel drug targets, as a consequence, this ROS-mediated excessive damage to cellular functions, including oncogenic mutagenesis, has also been implicated in inducing chemoresistance. This remains one of the major challenges in the treatment and management of human malignancies. Antioxidant-enriched natural compounds offer one of the promising approaches in mitigating some of the underlying mechanisms involved in tumorigenesis and metastasis, and therefore, have been extensively explored in cancer chemoprevention. Among various groups of dietary phytochemicals, polyphenols have been extensively explored for their underlying chemopreventive mechanisms in other cancer models. Thus, the current review highlights the significance and mechanisms of some of the highly studied polyphenolic compounds, with greater emphasis on pancreatic cancer chemoprevention.

Aims Prior studies have focused on the role of the kidney and vasculature in salt-induced modulation of blood pressure; however, recent data indicate that sodium accumulates in tissues and can activate immune cells. We sought to examine mechanisms by which salt causes activation of human monocytes both in vivo and in vitro. Methods and results To study the effect of salt in human monocytes, monocytes were isolated from volunteers to perform several in vitro experiments. Exposure of human monocytes to elevated Na+ex vivo caused a co-ordinated response involving isolevuglandin (IsoLG)-adduct formation, acquisition of a dendritic cell (DC)-like morphology, expression of activation markers CD83 and CD16, and increased production of pro-inflammatory cytokines tumour necrosis factor-α, interleukin (IL)-6, and IL-1β. High salt also caused a marked change in monocyte gene expression as detected by RNA sequencing and enhanced monocyte migration to the chemokine CC motif chemokine ligand 5. NADPH-oxidase inhibition attenuated monocyte activation and IsoLG-adduct formation. The increase in IsoLG-adducts correlated with risk factors including body mass index, pulse pressure. Monocytes exposed to high salt stimulated IL-17A production from autologous CD4+ and CD8+ T cells. In addition, to evaluate the effect of salt in vivo, monocytes and T cells isolated from humans were adoptively transferred to immunodeficient NSG mice. Salt feeding of humanized mice caused monocyte-dependent activation of human T cells reflected by proliferation and accumulation of T cells in the bone marrow. Moreover, we performed a cross-sectional study in 70 prehypertensive subjects. Blood was collected for flow cytometric analysis and 23Na magnetic resonance imaging was performed for tissue sodium measurements. Monocytes from humans with high skin Na+ exhibited increased IsoLG-adduct accumulation and CD83 expression. Conclusion Human monocytes exhibit co-ordinated increases in parameters of activation, conversion to a DC-like phenotype and ability to activate T cells upon both in vitro and in vivo sodium exposure. The ability of monocytes to be activated by sodium is related to in vivo cardiovascular disease risk factors. We therefore propose that in addition to the kidney and vasculature, immune cells like monocytes convey salt-induced cardiovascular risk in humans., Graphical Abstract

The two main sources of CH4 from the agricultural sector are enteric fermentation and manure management systems. Canada uses the IPCC Tier-II methodology to estimate CH4 for its national inventory report of GHG emissions to UNFCCC, which is based on a bottom-up approach using activity data and emission factors obtained through site level experimental measurements. However, because of the presence of wetlands in some agricultural regions, it has been challenging to obtain accurate CH4 emission estimates at a regional scale.This study explores the usefulness of S5P methane product for verifying methane emission estimates in eastern Ontario agricultural land. We investigated the spatiotemporal variability of total column methane mixing ratio, as well as other detailed data layers in the TROPOMI product, such as averaging kernels and a prior profiles. The spatial temporal patterns of wetland methane emission derived from the global WetCHARTs dataset, and a prior knowledge of livestock distribution in the region, are used to interpret S5P methane product. Results showed that TROPOMI methane product provides great spatiotemporal coverage that can be used to verify CH4 emissions from agricultural landscape. This will be useful to reduce methane estimation uncertainties at the regional and national scales.

Highly sensitive detection of heat denatured Herceptin® (trastuzumab), an important monoclonal antibody used in breast cancer therapeutics, is demonstrated using transverse magnetic (TM) mode suspended microring resonators (MRRs). The suspended MRRs are surface functionalized with a single chain fragment variable (scFv) recombinant antibody molecule (designated 2B4) that enables selective capture of denatured Herceptin molecules. Interaction between guided modes in suspended MRRs and Herceptin molecules captured on the surfaces of the suspended MRRs enable straightforward optical detection and quantification of the bound Herceptin molecules. Clinically relevant Herceptin detection at a concentration of 100 nM is demonstrated and negligible signal was obtained from the sensor when exposed to Avastin® (bevacizumab), a negative control human therapeutic monoclonal antibody. Importantly, at least a 2-fold enhanced detection sensitivity is obtained by suspending the microring (MRR) over the underlying substrate, effectively increasing the sensing surface area. Experimental results are supported by three-dimensional finite-difference time-domain simulations and optical mode analysis. The use of a label-free silicon photonic platform for high sensitivity molecular detection is compatible with high-throughput, low-cost diagnostics employing on-chip sensor arrays.

Aim To compare the efficacy and safety of the dipeptidyl peptidase‐4 inhibitor sitagliptin with the sodium‐glucose transporter‐2 inhibitor dapagliflozin in patients with type 2 diabetes and mild renal insufficiency. Materials and Methods Patients with HbA1c ≥7.0 to ≤9.5% (≥53 to ≤80 mmol/mol) and estimated glomerular filtration rate ≥60 to

The effects of manure management practices on ammonia (NH3) emissions were evaluated using a micrometeorological technique at four contrasting dairy storage facilities: untreated raw manure slurry (RM), solid-liquid separation with storage of separated liquids (SL), anaerobic digestion of manure and off-farm materials (AD), and anaerobic digestion with solid-liquid separation and storage of the liquid fraction (ADL). Annual average NH3 emissions per surface area were lowest for RM (2.7 g m−2 d−1), followed by SL (4.5 g m−2 d−1), AD (10.0 g m−2 d−1), and ADL (15.5 g m−2 d−1). Lower NH3 emissions from the RM storage were partly due to the 30 cm thick surface crust which formed on the storage surface in summer (wood shavings was used as bedding). Greater surface crusting at the AD storage compared to the ADL storage was also likely the reason for higher emissions at the ADL storage. Relationships between NH3 emissions, temperature, and wind-speed were observed at all sites but were strongest at sites with minimal crusting (SL, ADL) and weak at the RM storage with a crust cover. Total NH3 emissions from each storage facility (kg y−1) did not simply track the differences in fluxes; rather, facilities with greater storage (RM, AD, ADL) had higher emissions than the facility with less storage (SL) due to removal of solids and more frequent field application. Overall, bedding material, manure processing, and storage management all have important effects on NH3 emissions from manure storage.

Kinetics studies of L-tyrosine (LTy) ortho-hydroxylation by mushroom tyrosinase (MT) confirmed that MT was severely, but not completely, inhibited at higher concentrations of LTy. Despite the availability of the crystal structure reports, no allosteric site has been identified on MT. To examine the assumption that a non-specific binding site works as a regulatory site, docking simulations were run for the second molecule of L-tyrosine (LTy2) on the complexes of the first L-tyrosine molecule (LTy1) with the heavy chain (H) of MT (LTy1/HMT) and its dimer with the light chain (Ty1/LHMT). In both, LTy2 occupied a non-specific binding site (MTPc). MD simulations revealed LTy2/HMT/LTy1 and LTy2/LHMT/LTy1 were stable. Binding free-energy analysis supported the formation of LTy2/HMT/LTy1 and LTy2/LHMT/LTy1 at higher concentrations of LTy and disclosed the importance of ΔEelec and ΔGpolar during binding of LTy2 to MTPc. Upon LTy2 binding to MTPc, the Cu-Cu distance remained unchanged while the spatial position of LTy1 in the active site (MTPa) changed so that it would not be able to participate in ortho-hydroxylation. This study suggests a tuning role for L chain during binding of the ligands to MTPa and MTPc. Given these results, a plausible mechanism was proposed for the MT substrate inhibition.

Extract of the Japanese apricot (JAE) has biological properties as an antioxidant and anti-inflammatory agent. We hypothesized that JAE might exert therapeutic effects on cigarette smoke (CS)-induced DNA damage and cytotoxicity. In this study, we found that concentrated JAE protects against cigarette smoke extract (CSE)-induced cytotoxicity and DNA damage accompanied by increased levels of aldehyde dehydrogenase (ALDH)2, 3A1, and Werner’s syndrome protein (WRN) in immortalized human bronchial epithelial cells (HBEC2) and normal human epidermal keratinocytes (NHEK). Using the centrifugal partition chromatography (CPC) method, we identified an undescribed compound, 5-hydroxymethyl-2-furaldehyde bis(5-formylfurfuryl) acetal (which we named FA-1), responsible for the protective effects against CSE. This chemical structure has not been reported from a natural source to date. Protective effects of isolated FA-1 against CSE were observed in both HBEC2 and NHEK cells. The studies described herein suggest that FA-1 isolated from JAE protects against CSE-induced DNA damage and apoptosis by augmenting multiple isozymes of ALDH and DNA repair and reducing oxidative stress.

3D scaffold-based in vitro cell culturing is a recent technological advancement in cancer research bridging the gap between conventional 2D culture and in vivo tumours. The main challenge in treating neuroblastoma, a paediatric cancer of the sympathetic nervous system, is to combat tumour metastasis and resistance to multiple chemotherapeutic drugs. The aim of this study was to establish a physiologically relevant 3D neuroblastoma tissue-engineered system and explore its therapeutic relevance. Two neuroblastoma cell lines, chemotherapeutic sensitive Kelly and chemotherapeutic resistant KellyCis83 were cultured in a 3D in vitro model on two collagen-based scaffolds containing either glycosaminoglycan (Coll-GAG) or nanohydroxyapatite (Coll-nHA) and compared to 2D cell culture and an orthotopic murine model. Both neuroblastoma cell lines actively infiltrated the scaffolds and proliferated displaying >100-fold increased resistance to cisplatin treatment when compared to 2D cultures, exhibiting chemosensitivity similar to orthotopic xenograft in vivo models. This model demonstrated its applicability to validate miRNA-based gene delivery. The efficacy of liposomes bearing miRNA mimics uptake and gene knockdown was similar in both 2D and 3D in vitro culturing models highlighting the proof-of-principle for the applicability of 3D collagen-based scaffolds cell system for validation of miRNA function. Collectively, this data shows the successful development and characterisation of a physiologically relevant, scaffold-based 3D tissue-engineered neuroblastoma cell model, strongly supporting its value in the evaluation of chemotherapeutics, targeted therapies and investigation of neuroblastoma pathogenesis. While neuroblastoma is the specific disease being focused upon, the platform may have multi-functionality beyond this tumour type. Statement of Significance Traditional 2D cell cultures do not completely capture the 3D architecture of cells and extracellular matrix contributing to a gap in our understanding of mammalian biology at the tissue level and may explain some of the discrepancies between in vitro and in vivo results. Here, we demonstrated the successful development and characterisation of a physiologically relevant, scaffold-based 3D tissue-engineered neuroblastoma cell model, strongly supporting its value in the evaluation of chemotherapeutics, targeted therapies and investigation of neuroblastoma pathogenesis. The ability to test drugs in this reproducible and controllable tissue-engineered model system will help reduce the attrition rate of the drug development process and lead to more effective and tailored therapies. Importantly, such 3D cell models help to reduce and replace animals for pre-clinical research addressing the principles of the 3Rs.

BACKGROUND Our aim was to determine the impact of converting from tacrolimus to belatacept in patients with stable low estimated glomerular filtration rate (eGFR) early after kidney transplant. METHODS This is a single-center retrospective case control study. During this study period, we had a clinical protocol to convert patients to belatacept if they had a stable but low GFR and they were at least 1-month posttransplant. Eligible patients had stable but low eGFR usually < 40 mL/min per 1.73 m. We used direct matching to select 1 control case for each patient converted to belatacept. The primary outcome was the change in eGFR from the point of belatacept conversion to 4 months postconversion (delta eGFR). RESULTS There were 30 patients in the conversion group and 30 in a direct matched control group. The median preconversion eGFR for the entire cohort was 23.0 mL/min per 1.73 m with an interquartile range of 15.7 to 31.4. The delta eGFR was 11.0 (12.9) mL/min per 1.73 m in belatacept group and 4.8 (10.5) mL/min per 1.73 m in the control group (P = 0.045). Acute rejection postconversion occurred in 5 (16.7%) in the conversion group and none of the control group (P = 0.052). Although the delta improvement in eGFR was about 6 mL/min better in the Belatacept group, there was no difference in the slope of inverse creatinine during the 12-month period after conversion between the groups. CONCLUSIONS We conclude that early belatacept conversion in kidney transplant recipients with stable low eGFR may only result in a modest increase in GFR.