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Purpose: Maximum tolerated dose, safety, pharmacokinetics, and pharmacodynamics were assessed in this phase 1 study of PNT2258, a BCL-2-targeted liposomal formulation of a 24-base DNA oligonucleotide called PNT100. Methods: Patients with malignant solid tumors were assigned sequentially to one of ten dose-escalation cohorts of PNT2258 at 1, 2, 4, 8, 16, 32, 64, 85, 113, and 150 mg/m administered intravenously on days 1 through 5 of each 21-day cycle. Pharmacokinetics were determined on days 1 and 5 of the first cycle. Lymphocyte and platelets concentrations were measured for evidence of BCL2-targeted effect. CT scans were used to identify radiologic evidence of anti-tumor effect. Results: Twenty-two subjects received PNT2258, and the maximum tolerated dose for PNT2258 was not reached. Doses at or above 32 mg/m resulted in exposure to PNT2258 above the exposure level required for anti-tumor activity in preclinical xenograft testing of 22,377 ng h/ml (PK analysis ). Fatigue was the most commonly reported adverse event. Dose-limiting toxicity, manifesting as a transient increase in aspartate aminotransferase, occurred at 150 mg/m, the highest dose tested. Four subjects, two each with diagnosis of non-small-cell lung cancer and sarcoma, treated at doses of 64 mg/m or higher, remained on study for 5-8 cycles. Conclusions: PNT2258 was safe and well tolerated at the doses tested up to 150 mg/m. Exposure to PNT2258 resulted in clinically manageable decreases in lymphocyte and platelet concentrations. [ABSTRACT FROM AUTHOR]

Abstract: Bis(4,5-dimethyl-2-pyridyl)-, bis(5-methyl-2-pyridyl)- and bis(4-methyl-2-pyridyl) diselenide have been synthesized directly from 3,4-lutidine (1a), 3-picoline (1b) and 4-picoline (1c) respectively via BF3 aided lithiation reaction. The lithiation of 3,4-lutidinium-, 3- and 4-picolinium-BF3 adduct (2a/2b/2c) gives the corresponding carbanion (3a/3b/3c) which on subjecting to selenium insertion reaction followed by aerial oxidation affords the related diselenide in good yield. Reaction of BF3 complexed pyridylselenolate anion (4a/4b/4c) with diiodomethane gives the corresponding bis(2-pyridylseleno)methane. The dilithiation of 4-picolinium-/pyridinium-BF3 adduct (2c/2d) followed by reaction with 2.2equiv. of selenium and iodomethane affords the related 2,6-bis(methylselenenyl)pyridine and 2-(methylselenenyl)pyridine in varying proportions. Preparation of tris(methylselenenyl) derivatives of 1a and 1c have been given in the present study. LiAlH4 has also been utilized to synthesize unsymmetrical monoselenides from the corresponding diselenides. Single crystal X-ray studies of bis(4,5-dimethyl-2-pyridyl) diselenide (5a), 3,4-dimethyl-2,6-bis(methylselenenyl)pyridine (9a), 4-methyl-2,6-bis(methylselenenyl)pyridine (9c), 2,6-bis(methylselenenyl)pyridine (9d) and 4-methyl-2,6-bis(methylselenenyl)-4-(methylselenenylmethyl)pyridine (12a) have also been carried out. The crystal data of these compounds reveals that the instances of Se⋯Se secondary interactions decreases with the increase in the number of methyl group attached to the pyridine ring. [Copyright &y& Elsevier]

Background: There is high inter-individual variability in clozapine metabolism due to genetic and non-genetic differences. Patient-specific factors such as smoking, inflammation indicated by elevated C-reactive protein (CRP), and certain concurrent medications have a significant influence on clozapine metabolism., Aim: To assess which patient-specific factors best explain variability in clozapine metabolism estimated by clozapine concentration to dose (C/D) ratios., Methods: A retrospective cohort analysis using electronic medical data was conducted on 172 inpatients at the BC Psychosis Program. Patients with normal renal and liver function were included if they were on clozapine and had at least one steady-state plasma concentration. The degree of influence of each factor on the variability of clozapine metabolism in the entire cohort and subgroups stratified by fluvoxamine use was evaluated using multiple linear regression analysis of C/D ratios., Results: Model fit testing showed that the entire cohort model accounts for 52.7% of C/D ratio variability, while the no fluvoxamine and fluvoxamine models accounted for 40.8% and 43.8%. In the entire cohort ( n = 172), fluvoxamine use explained the highest variance, and C/D ratios were higher by 30.6% on average. The second strongest predictor was elevated CRP > 10 mg/L, and C/D ratios were higher by 22.9% on average. Subsequently, obesity, nonsmoker status, and female sex explained a significant but modest proportion of variance. Among participants on fluvoxamine ( n = 58), only fluvoxamine dose was associated with an increase, and for every 25 mg increase in dose, C/D ratios increased by 5% on average., Conclusion: In a clinical population, this study replicated the relationship between reduced rate of clozapine metabolism and the use of fluvoxamine, elevated CRP, obesity, nonsmoking status, and female sex; and the magnitude of the effects were large enough to be clinically relevant., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RR, AS, AR, NB, and KK have none to declare, AMB reports receiving research funding from Boehringer Ingelheim, RFW has received income from Canadian Agency for Drugs and Technologies in Health and Advisory Board Activities for HLS Therapeutics, CGS is a consultant to Clearmind Medicine, and CAB is founder and CEO of Sequence2Script Inc.

Introduction: An increasing growth of systematic reviews (SRs) presents notable challenges for decision-makers seeking to answer clinical questions. In 1997, an algorithm was created by Jadad to assess discordance in results across SRs on the same question. Our study aims to (1) replicate assessments done in a sample of studies using the Jadad algorithm to determine if the same SR would have been chosen, (2) evaluate the Jadad algorithm in terms of utility, efficiency and comprehensiveness, and (3) describe how authors address discordance in results across multiple SRs., Methods and Analysis: We will use a database of 1218 overviews (2000-2020) created from a bibliometric study as the basis of our search for studies assessing discordance (called discordant reviews). This bibliometric study searched MEDLINE (Ovid), Epistemonikos and Cochrane Database of Systematic Reviews for overviews. We will include any study using Jadad (1997) or another method to assess discordance. The first 30 studies screened at the full-text stage by two independent reviewers will be included. We will replicate the authors' Jadad assessments. We will compare our outcomes qualitatively and evaluate the differences between our Jadad assessment of discordance and the authors' assessment., Ethics and Dissemination: No ethics approval was required as no human subjects were involved. In addition to publishing in an open-access journal, we will disseminate evidence summaries through formal and informal conferences, academic websites, and across social media platforms. This is the first study to comprehensively evaluate and replicate Jadad algorithm assessments of discordance across multiple SRs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)