November 29, 2010

The Faces of Hepatitis C

The Faces of Hepatitis C

You are a doctor or a nurse--You are a fifth grade grade teacher

Your skin is white or brown or black--you are Mecxican or Asian,
Caucasian,or African American

You are very old, have grandchildren,near the end of your golden
years

You are middle-aged--children grown and gone-ready to "enjoy"
your life --

You are a young mother with a small child-a young father trying to
provide for his family--

You are a teenager--waiting for proms,boy or girlfriends, your first
kiss dreaming of college and a car of your own--

You are a newborn lying in your mother's arms

YOU are the Faces of Hepatitis C

I may not recognize you as you pass me on the street or in the store
where I shop or the church where I worship, but you are there

The Faces of Hepatitis C

My heart cries out for you,for what fate has given you--it was not
your fault--it was just meant to be

My heart swells with pride for you--your courage,your faith--you
have been asked to keep going when others would have given
up

You wait anxiously for another loving person to give you the
"The Gift of Life"

The gift of their own liver at the end of THEIR life.
I am filled with love for each of you--my brother--my sister
and those I have met and those I will never know--

You see--I am one of those faces

The faces of Hepatitis

Given by God...written by Selles Dole

Selles lost her battle with HCV November 29, 2008

May You Always Sleep In The Arms Of Angels

FDA Approves Merit Medical's HiQuality Clinical Trial Protocol for the Treatment of Primary Liver Cancer

Nov 29, 2010 (GlobeNewswire via COMTEX) --

First large-scale multi-site U.S. study comparing doxorubicin-eluting QuadraSphere(TM) Microspheres to conventional chemoembolization

Interventional radiologists from U.S., Europe, South America participating in liver cancer study

SOUTH JORDAN, Utah, Nov. 29, 2010 (GLOBE NEWSWIRE) -- The Food and Drug Administration (FDA) has approved Merit Medical Systems, Inc.'s /quotes/comstock/15*!mmsi/quotes/nls/mmsi (MMSI 14.89, -0.06, -0.40%) phase 3 clinical trial protocol to treat primary liver cancer with QuadraSphere(TM) Microspheres (hqTACE) for delivery of doxorubicin. The clinical trial will involve U.S. and international interventional radiologists who treat patients with localized, unresectable hepatocellular carcinoma (HCC), the most common form of liver cancer. The FDA action will result in the first phase 3 study in the U.S. comparing drug-eluting microspheres to conventional chemoembolization (cTACE) in the treatment of hepatocellular carcinoma. Currently in the U.S. there is no FDA-approved embolic for the treatment of liver cancer.

QuadraSphere is indicated for embolization of hypervascular tumors and peripheral arteriovenous malformations. The identical product marketed in Europe as HepaSphere Microspheres(TM) has been CE-marked in the European Union since 2007 for embolization of HCC and hepatic metastases, with or without delivery of doxorubicin.

"I am extremely pleased with the efforts of our BioSphere Regulatory and Medical Affairs Department headed by Dr. Melodie R. Domurad, PhD," said Fred P. Lampropoulos, Merit's Chairman and Chief Executive Officer. "We are very excited about the initiation of this important study."

Merit Medical is a leading manufacturer and marketer of proprietary disposable devices used primarily in cardiology, radiology and endoscopy. It has recently added the BioSphere microsphere products to its line of tumor treatment options.

The phase 3 study is a prospective, randomized, blinded and controlled investigation of HepaSphere/QuadraSphere Microspheres for delivery of doxorubicin for the treatment of hepatocellular cancer. Known as the HiQuality Study (HepaSphere/QuadraSphere in Liver Cancer Treatment), the primary endpoint of the clinical trial is survival. Secondary endpoints include tumor response by mRECIST criteria, safety, resource utilization such as length of hospitalization, and adverse events. The study will enroll 500 patients and be conducted in approximately 20 clinical sites in the U.S., Europe, and South America.

Dr. Riccardo Lencioni, who developed the guidelines for image acquisition and interpretation for the trial stated, "This study meets the highest standards for clinical research in hepatocellular carcinoma, as recommended in Design and Endpoints of Clinical Trials in Hepatocellular Carcinoma, guidelines for clinical research in HCC by an expert panel convened by the American Association for the Study of Liver Disease, and published in the Journal of the National Cancer Institute. The design of the investigation is rigorous, and has been extensively reviewed by the FDA."

Dr. Lencioni, M.D., Associate Professor of Radiology at the University of Pisa in Italy and Director of the Division of Diagnostic Imaging and Intervention at the Department of Hepatology and Liver Transplantation at the Pisa University Hospital, will be overseeing the central imaging review and evaluation of tumor response. Professor Lencioni is Chairman of the Membership Committee and a member of the Executive Committee of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Chairman of the Programme Committee of the European Conference on Interventional Oncology (ECIO). He is also a member of the Steering Committee of the World Conference on Interventional Oncology (WCIO). Professor Lencioni has been one of the founders of the International Liver Cancer Association (ILCA), and is a member of the Governing Board. Professor Lencioni has received more than 40 international awards; authored 134 articles or editorials; and is the editor of seven books. Professor Lencioni has served on the editorial board of Cardiovascular and Interventional Radiology, Investigative Radiology, European Radiology, Journal of Hepatology, Journal of Interventional Oncology, and La Radiologia Medica.

Michael Soulen, M.D. from the University of Pennsylvania Medical Center and Professor of Radiology specializing in Interventional Radiology, will direct the study as principal investigator. Active in the Society of Interventional Radiology (SIR), Dr. Soulen has served on the Executive Council, chaired the 1999 Annual Scientific Meeting, and acted as Director of Research Education for the SIR Foundation. He also serves on committees of the Radiological Society of North America (RSNA) and the American College of Radiology (ACR). Dr. Soulen chairs the steering committee of the World Conference of Interventional Oncology (WCIO). He is also an editorial board member and/or reviewer for numerous publications, including the Journal of Vascular and Interventional Radiology. He has published nearly100 peer-reviewed articles and more than 50 editorials, chapters and invited manuscripts.

About Liver Cancer

Liver cancer is the third leading cause of cancer deaths worldwide. The sharp rise in hepatitis C infections, alcohol consumption and obesity are reported as key contributing factors to the increase in liver cirrhosis and liver cancer. Liver transplantation or tumor resection is considered potentially a curative treatment; however, only about 25 percent of liver cancers are diagnosed when they can be treated surgically.

Surgical removal is not possible for more than two-thirds of primary liver cancer patients and 90 percent of patients with secondary liver cancer. According to the U.S. National Cancer Institute (NCI), no standard treatment currently exists for liver cancer when tumors cannot be surgically removed and liver transplantation is not a viable option. However, both the NCI and the Society of Interventional Radiologists (SIR) report that transarterial chemoembolization (TACE) has shown promising results.

hqTACE - Merit Advances Chemoembolization

Drug-eluting embolization treats hepatocellular carcinoma through the dual action of delivering chemotherapy into the tumors while also cutting off the blood supply that supports them. QuadraSphere adds two benefits to embolization therapy. First, by ionically binding the doxorubicin throughout the microspheres and eluting it into the cancer in a sustained manner, more drug can be delivered into the tumor, with less escaping into peripheral circulation. Complementary to the targeted delivery, QuadraSphere Microspheres have a unique formulation that makes them highly compressible and conformable, so they mold to the vessel lumen, creating both excellent contact with the vessel walls for delivery of chemotherapy and very efficient occlusion of the vessels feeding the tumor. Initial clinical results have demonstrated improved safety and reduced adverse events compared to treatment by conventional chemoembolization.

About Conventional Transarterial Chemoembolization (cTACE)

Conventional transarterial chemoembolization (cTACE) is a two-stage process involving the injection of chemotherapeutic drugs, typically emulsified with iodized oil, directly into the blood vessels that feed a tumor. The drug is followed by the delivery of an embolic agent used as a plug to block the tumor's blood supply and temporarily retain the cytotoxic drugs in place. However, the occlusion is limited in area and some of the chemotherapy still escapes into circulation, which leads to adverse effects.

About Merit

Founded in 1987, Merit Medical Systems, Inc. is engaged in the development, manufacture and distribution of proprietary disposable medical devices used in interventional and diagnostic procedures, particularly in cardiology, radiology and endoscopy. Merit serves client hospitals worldwide with a domestic and international sales force totaling approximately 130 individuals. Merit employs approximately 2,170 people worldwide with facilities in Salt Lake City and South Jordan, Utah; Angleton, Texas; Richmond, Virginia; Maastricht and Venlo, The Netherlands; Paris, France; Galway, Ireland; Beijing, China; Copenhagen, Denmark; and Rockland, Massachusetts.

The Merit Medical Systems, Inc. logo is available at http://www.globenewswire.com/newsroom/prs/?pkgid=3282

Statements contained in this release which are not purely historical are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and are subject to risks and uncertainties such as those described in Merit's Annual Report on Form 10-K for the year ended December 31, 2009. Such risks and uncertainties include risks relating to Merit's recent acquisition of BioSphere (including, without limitation, the risk that the operations of the two companies will not be integrated successfully; and the risk that Merit may be unable to successfully develop, commercialize and market new products and technology which Merit acquired through the acquisition); uncertainties associated with potential healthcare policy changes which may have a material adverse effect on Merit; possible infringement of Merit's technology or the assertion that Merit's technology infringes the rights of other parties; downturn of the national economy and the corresponding effect on Merit's revenues, collections and supplier relations; potential termination of supplier relationships, or failure of suppliers to perform; product recalls and product liability claims; delays in obtaining regulatory approvals, or the failure to maintain such approvals; Merit's inability to successfully manage growth through acquisitions, including the inability to commercialize technology acquired through recent, proposed or future acquisitions, including without limitation the Endotek acquisition; concentration of Merit's revenues among a few products and procedures; development of new products and technology that could render Merit's products obsolete; market acceptance of new products; introduction of products in a timely fashion; price and product competition; availability of labor and materials; cost increases; fluctuations in and obsolescence of inventory; volatility of the market price of Merit's common stock; foreign currency fluctuations; changes in key personnel; work stoppage or transportation risks; modification or limitation of governmental or private insurance reimbursement policies; changes in health care markets related to health care reform initiatives; impact of force majeure events on Merit's business, including severe weather conditions; failure to comply with applicable environmental laws; and other factors referred to in Merit's Annual Report on Form 10-K for the year ended December 31, 2009 and other materials filed with the Securities and Exchange Commission. All subsequent forward-looking statements attributable to Merit or persons acting on its behalf are expressly qualified in their entirety by these cautionary statements. Actual results will differ, and may differ materially, from anticipated results. Financial estimates are subject to change and are not intended to be relied upon as predictions of future operating results, and Merit assumes no obligation to update or disclose revisions to those estimates.

This news release was distributed by GlobeNewswire, http://www.globenewswire.com/

SOURCE: Merit Medical Systems, Inc.

CONTACT: Merit Medical Systems, Inc.
Anne-Marie Wright, Vice President, Corporate Communications
(801) 208-4167
Fax: (801) 253-1688
awright@merit.com

Source

Study Highlights Liver Health Risk in UK

Large numbers of people are putting liver health at risk as they shun visits to GP on alcohol related matters' says new study but new test can help. The LiverCheck test developed by YorkTest can be used at home and is an easy way to understand the health of your liver.

LEEDS, England, Nov. 25, 2010 /PRNewswire/ -- Growing groups of the so-called "worried well" are putting their lives at risk by shunning visits to their GP over alcoholic health related matters, according to new evidence.

The study, which appears in Hepatology, based its findings on 1039 UK subjects (561 female/478 male) who took a LiverCheck home liver function test and showed that 73% would not consider going to their GP concerning their liver health, revealing the extent to which people are putting themselves at risk from liver disease.

Luckily LiverCheck, the UK's only home-to-lab blood testing kit, is able to help. The test, which is available from YorkTest Laboratories, can test for levels of the two enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which if found in high levels in the blood stream have been shown to increase higher risk of mortality.

Rajiv Jalan, Professor of Hepatology at University College London and co-author of the article says:

"This data confirms the medical importance of ALT and AST as a marker for premature mortality as a consequence of liver disease. Due to the nature of the illness, the symptoms only appear when irreversible damage has been done so a screening procedure to detect the early signs of liver damage is essential. A GP is always your first port of call but for some a self test does have a vital role to play in saving lives."

Further findings from the study also paint a worrying picture of the UK's current drinking habits with 44% admitting they drink alcohol on a daily basis. 26% also admitted they regularly consumed more than twice the government guidelines on safe drinking and with Christmas and New Year fast approaching it is thought that this figure could double.

It is hoped with the easy to use LiverCheck that people are able to understand their liver health helping to address a potentially life threatening problem which previously had been unavailable to thousands of people adversely affected by alcohol consumption.

The LiverCheck Liver Function Test is currently available from YorkTest for 99 pounds. YorkTest are based in York, West Yorkshire and specialise in home laboratory tests including food intolerance testing, allergy testing, homocysteine tests, and more. For more information visit http://www.yorktest.com/.

Dr. Gillian Hart
YorkTest
0800 074 6185
customercare@yorktest.com

SOURCE YorkTest
RELATED LINKS
http://www.yorktest.com/

Source

Therapeutic Acetaminophen Not Linked to Liver Injury in Children

Laurie Barclay, MD

November 29, 2010 — Hepatoxicity after therapeutic dosing of acetaminophen in children is rarely reported in defined-population studies, according to the results of a systematic review reported online November 22 in Pediatrics.

"Use of the drug has recently come under increased scrutiny by the Food and Drug Administration because of the increased recognition of the contribution of acetaminophen to acute liver injury globally," Dr. Laura James, section chief of clinical pharmacology and toxicology at Arkansas Children's Hospital and professor of pediatrics at University of Arkansas for Medical Sciences, told Medscape Medical News when asked for independent comment. "While most experts view acetaminophen to be safe when used as directed, there have been rare reports of toxicity occurring with recommended dosing of the drug. Individual susceptibilities in drug response and toxicity may occur with the use of any drug, including acetaminophen."

Eric J. Lavonas, MD, from Rocky Mountain Poison and Drug Center at Denver Health in Colorado, and colleagues systematically reviewed the medical literature to assess the rate at which liver injury has been reported for children prescribed therapeutic doses of acetaminophen, defined as up to 75 mg/kg per day orally or intravenously or up to 100 mg/kg per day rectally.

Studies in which acetaminophen was given to a defined pediatric population for at least 24 hours were identified from a search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Trained reviewers also searched these sources for all case reports of liver injury after therapeutic acetaminophen dosing and extracted data from each report. Major and minor hepatic adverse events (AEs) were defined prospectively, and the Naranjo algorithm allowed evaluation of causality.

Among 62 identified studies enrolling a total of 32,414 children, there were no reports (0%; 95% confidence interval [CI], 0.000 - 0.009) of a child showing signs or symptoms of liver disease, having received an antidote or liver transplantation, or having died. A total of 10 children were reported to have major or minor hepatic AEs (0.031%; 95% CI, 0.015 - 0.057), and the highest transaminase value reported was 600 IU/L, with Naranjo scores (2 - 3) suggesting "possible" causation. However, none of the children had other evidence of liver dysfunction.

Among 22 identified case reports, there were 9 cases in which the Naranjo score suggested "probable" causation. The investigators concluded that hepatoxicity after therapeutic dosing of acetaminophen in children is rarely reported in defined-population studies. Although case reports suggest that this phenomenon may occur, few reports contain sufficient data to support a probable causal relationship.

"The limitations of the report are that the study reviewed previously published studies that were not expressly designed to systematically collect laboratory measurements that would detect liver injury," Dr. James said. "The clinical signs and symptoms of liver injury can be subtle until significant liver injury is present. Acetaminophen is a drug with a narrow safety index and thus careful dosing of the drug is a necessity for safe use."

Other limitations noted by the study authors include imperfect indexing strategies of medical databases, publication bias, possible errors introduced by manual search, possible failure to detect liver inflammation in some children, lack of routine blood testing on children without signs or symptoms of liver injury in most studies, and possible differences in clinical trial participants from the general population of children who take acetaminophen. A major limitation that the reviewers pointed out is that incomplete safety reporting is common in published clinical trials.

The reviewers also warn that their findings should not be used to estimate the proportion of children taking acetaminophen who experience elevations in asymptomatic transaminase levels, because if routine screening had been performed in all studies, it would likely have revealed additional cases of hepatic enzyme elevation. They also note that threshold criteria used to define severe liver injury are arbitrary. Because few children in these studies received exactly 75 mg/kg per day of acetaminophen, and many did not receive the drug for longer than 3 to 5 days, this study has limited power to detect infrequent hepatic AEs associated with longer therapy and/or maximal therapeutic dosing.

"Pediatricians should continue to educate families and patients about the safe use of acetaminophen, including informing families about the widespread use of acetaminophen in many over-the-counter products and prescription pain medications," Dr. James concluded. "Ongoing studies will help determine the factors that may contribute to individual susceptibilities to acetaminophen-induced liver injury."

This review was internally funded. The Rocky Mountain Poison and Drug Center, Denver Health receives research funding from McNeil Consumer Healthcare, but the development and analysis of the database described in the review article was not supported by McNeil Consumer Healthcare. The study authors have disclosed no relevant financial relationships. Dr. James is the recipient of 2 National Institutes of Health grants for the study of acetaminophen toxicity. She also has a patent pending for the measurement of acetaminophen protein adducts in human blood samples.

Pediatrics. Published online November 22, 2010. Abstract

Source

Immunitor Awarded the Key U.S. Patent Related to Oral Vaccine Technology Platform

PRESS RELEASE

Nov. 29, 2010, 7:38 a.m. EST

VANCOUVER, British Columbia, Nov 29, 2010 (GlobeNewswire via COMTEX) -- Immune Network Ltd. /quotes/comstock/11i!immff (IMMFF 0.03, +0.02, +194.12%) , advises that its potential acquisition, Immunitor USA Inc., has been issued a key patent by the U.S. Patent and Trademark Office (USPTO).

The patent (US 7,838,006 "Viral vaccine composition, process and methods of use") contains claims covering the composition of matter for Immunitor's lead product, V5. The patent also covers the process of making and use of the matter for treating and preventing the broad range of infectious diseases. Immunitor was previously awarded a U.S. patent covering another lead compound specifically designed for treatment of AIDS (US 7,384,637).

According to Vichai Jirathitikal, the principal inventor on these two patents, "The USPTO has validated the novelty and utility of Immunitor's technology and its use in the treatment and prophylaxis of a range of most diverse diseases and conditions." The co-inventor, Aldar Bourinbaiar, Immunitor's CEO, added: "With the issuance of these two patents, our lead programs are further protected, significantly enhancing their commercial value."

Over the course of the company's development, Immunitor has achieved a broad and deep intellectual-property position in the orally delivered immunotherapeutics area. The company's patent portfolio now includes more than eight pending patents (including two international), with at least two dozen scientific publications in the peer-reviewed medical literature describing various aspects of the technology in infectious and autoimmune diseases, cancer, and metabolic diseases such as atherosclerosis and obesity. The combined annual market for these and related indications is close to $100 billion.

Immunitor is the industry leader in tableted oral vaccines and immunotherapies. During the past three years Immunitor completed two phase II clinical trials using V5 for treatment of chronic hepatitis B and hepatitis C. This year Immunitor seized upon an unexpected clinical outcome, which revealed the intriguing potential of V5 in curing tuberculosis in almost 95% of patients within one month. The results of the first trial in patients with tuberculosis who were co-infected with hepatitis C virus and HIV were published in October issue of Journal of Vaccines and Vaccination (http://www.omicsonline.org/2157-7560/2157-7560-1-103.php). Patient enrollment for two additional phase 2b placebo-controlled trials involving 120 patients with difficult-to-treat forms of tuberculosis has been just completed in Ukraine and results are anticipated in early 2011.

To date, all clinical trials of V5 have provided strong evidence of an excellent safety profile and provided insights into the unparalleled efficacy that will guide Immunitor in the design of follow-on hepatitis and tuberculosis studies, which are now being arranged in South Africa, Pakistan, India and China.

Immune Network is continuing its work toward meeting the pre-conditions for completion of a merger or similar transaction with Immunitor. Several aspects of the updated corporation and its anticipated transactions will be announced early in December 2010.

A temporary website for Immune Network is at http://www.immune-network.com/. The Immune Network Ltd. logo is available at http://www.globenewswire.com/newsroom/prs/?pkgid=8008  .

Safe Harbor Statement

The information in this release, other than historical information, may be considered forward-looking statements within the provisions of the Private Securities Litigation Reform Act of 1995. Projection and other forward-looking statements and management expectations regarding future events and/or financial performance of the Company -- although given in good faith -- are inherently uncertain and actual events and/or results may differ materially.

This news release was distributed by GlobeNewswire, http://www.globenewswire.com/

SOURCE: Immune Network Ltd

CONTACT: Immune Network Ltd
IMMFF@yahoo.com

Source

The Lesser-Known Complications of HIV/AIDS

Erin N. Marcus, MD
Posted: November 29, 2010 07:51 AM

At the age of 56, Jules Levin felt pretty invincible, despite being HIV positive. He went to the gym regularly and controlled his disease well by taking his antiretroviral medicines every day.

Then he slipped one day while on vacation and broke his wrist. He underwent an operation to insert pins in his bones and needed to wear a cast for a month, keep his arm elevated, and then do physical therapy for two months to get to the point where he could lift a five pound weight. "It was one of the most difficult things I've ever been through in my life," he said. "I ran, biked, lifted weights and now all of a sudden I couldn't turn the page of a newspaper. It just really got to me."

After a few simple tests, the reason for Levin's fracture became clear: His bones were weak from osteoporosis, a disease that's most commonly seen in older women, but that's also associated with HIV.

"The giddiness of the age of HAART is over," said Levin, referring to highly active antiretroviral therapy, the life-saving drug regimen prescribed to people with HIV. "We should have an aging clinic in every hospital that's serving HIV patients."

Osteoporosis is one of many conditions associated with old age that is now being seen with increasing frequency in people with HIV. Research suggests that long-term exposure to the virus, and to the inflammation it triggers, make people vulnerable to premature aging and to a host of conditions seen with aging, heart and kidney disease, dementia, and osteoporosis.

Additionally, the overall population of people with HIV is getting older, thanks to improved medical therapy. At present, 1 in 4 people with HIV is age 50 or older. The U.S. Senate Special Committee on Aging has predicted that half of all adults with HIV will be older than 50 by the year 2015. Over the past few years, the National Institute of Health has increased its funding for research on HIV and aging, and the White House hosted a conference on October 27 on HIV and aging.

"The evidence is pretty clear," said Levin, who directs The National AIDS Treatment Advocacy Project (NATAP), a New York-based HIV education and advocacy group. "We're going to see early frailty, early senescence and people are going to start dying at earlier ages."

Compared to other conditions associated with HIV and aging, osteoporosis is relatively straightforward to forestall and treat. To maintain bone strength, it's important for all people with HIV to make sure they are consuming an adequate amount of calcium and Vitamin D. A recent article in the journal Clinical Infectious Diseases recommends 1,000 to 1,500 mg of calcium and 800 to 1,000 IUs of Vitamin D daily, as well as at least 30 minutes of weight-bearing exercise, such as jogging or walking, at least three days a week. Calcium is plentiful in dairy products and sardines, and is available in supplements such as calcium carbonate and calcium citrate. The National Institutes of Health has an online information sheet listing ways to get calcium. It's also important to avoid smoking and heavy alcohol use, since these can cause osteoporosis.

HIV is thought to be associated with osteoporosis for a variety of reasons. The infection, itself, causes inflammation, which in turn impacts the cells that maintain bones. Many conditions common in people with HIV, such as Vitamin D deficiency, being underweight and low testosterone, are associated with osteoporosis. Antiretroviral therapy and other medications frequently prescribed to people with HIV, such as Prednisone, also cause bone loss.

Even though many antiretrovirals can cause bone loss, osteoporosis is not a reason to stop taking them. "Antiretroviral therapy is life-saving, and we know that stopping antiretroviral therapy is not a good strategy for preventing complications," said Dr. Todd Brown, an endocrinology specialist at Johns Hopkins University who co-wrote the article in Clinical Infectious Diseases.

Brown and his coauthors recommend that all HIV-positive men older than age 50 and women who are past menopause undergo testing for osteoporosis, since it's a condition that usually doesn't cause symptoms until the person breaks a bone. His own research has found that osteoporosis is "alarmingly" prevalent among African Americans in inner city Baltimore. "Because of the perception that osteoporosis is a white disease, people of color get short shrift for screening," he said. "This concept that African Americans are protected shouldn't be a reason to neglect them."

Once someone is diagnosed with osteoporosis, it's important to take action to prevent falling, such as removing clutter and slippery rugs from the floor. Physical therapy can help improve strength and balance, which also reduce the risk of a fall. The person also should get his or her vision checked and review his or her medication list with a doctor to try to minimize any drug side effects or interactions that might cause drowsiness or unsteadiness.

A class of medicines called bisphosphonates can improve bone strength, but do have some rare risks. "While they do decrease the risk of fracture, they're not totally benign drugs," Brown said. "On the flip side, you shouldn't not use them in the patient who is at high risk of a fracture."

Levin urges all people with HIV to be assertive about discussing osteoporosis and other age-related conditions with their doctor. "My guess is that 90 percent of patients know nothing about any of this and a lot of clinicians and case managers don't know about it either," he said. "Every patient should ask their clinician, 'are you aware, are you monitoring me for heart disease, diabetes, bone disease, cognitive impairment, kidney disease?' This is an important issue for everybody."

A similar version of this article originally appeared on the website of New America Media.

Source

November 28, 2010

First-ever covalent irreversible inhibition of a protease central to hepatitis C infection

Public release date: 28-Nov-2010
Contact: Kathryn Morris
kathryn@theyatesnetwork.com
914-204-6412
Yates Public Relations

Publication in Nature Chemical Biology demonstrates that irreversible covalent inhibition can increase selectivity, potency and duration of action, broadens applications for targeted covalent drugs to the protease gene family

WALTHAM, MA – November 28, 2010 – Avila Therapeutics™, Inc., a biotechnology company developing novel targeted covalent drugs, has published research in Nature Chemical Biology demonstrating the first-ever selective irreversible inhibition of a viral protease using a targeted covalent drug. In the paper titled "Selective Irreversible Inhibition of a Protease by Targeting a Non-Catalytic Cysteine", Avila used its proprietary Avilomics™ platform to design covalent irreversible protease inhibitors that are highly selective, potent and with superior duration of action as compared to conventional protease inhibitors.

Importantly, the published research demonstrates that covalent drugs can be designed and targeted to irreversibly and covalently bond to molecular domains specific to proteases. This is the first report of the irreversible covalent approach being successfully extended to proteases, a very broad class of proteins that includes many important potential drug targets.

"This research elevates covalent drug design to a fundamentally new level," said Simon Campbell, PhD, CBE, FMedSci, FRS, a renowned scientist and former Senior Vice President for Worldwide Drug Discovery and Medicinal R&D Europe of Pfizer. "By creating extremely selective protease inhibitors with their platform, Avila is showing the remarkable therapeutic potential of irreversible covalent drugs to address a broad spectrum of drug targets."

"This publication showcases the creation of a whole new class of small molecule drugs," said Juswinder Singh, PhD, Chief Scientific Officer of Avila and a co-author of the paper. "This approach can make a difference to patients living with HCV infection, and we expect to make an impact in other important areas such as cancer and inflammatory disease."

In order to maximize selectivity and minimize off-target effects, the irreversible covalent inhibitors of HCV protease were designed to covalently target a unique structure in the HCV protease not found in human proteases. Key findings include:

• A representative irreversible covalent inhibitor designed, by Avila, was shown to inhibit the HCV protease (also known as "NS3") in cells at a concentration of 6 nM .

• Specific covalent bond formation between the drug and target protease was demonstrated through use of mass spectrometry and also x-ray crystallography.

• Very high selectivity of the Avila compounds was demonstrated by showing no notable inhibition of a panel of human proteases in biochemical assays with additional specificity demonstrated in cellular assays; this was contrasted experimentally with Telaprevir, an HCV protease inhibitor in late-stage clinical testing which demonstrated off-target biochemical activity against several human targets.

Avila has subsequently optimized additional drug candidates, yielding current development candidates, AVL-181 and AVL-192, which have excellent pharmacokinetics and bind potently to wild- type HCV protease as well as multiple genotypes and mutant forms of HCV protease.

###

About Avila Therapeutics™, Inc.

Avila focuses on design and development of targeted covalent drugs to achieve best-in class outcomes that cannot be achieved through traditional chemistries. This approach is called "protein silencing". The company's product pipeline has been built using its proprietary Avilomics™ platform and is currently focused on viral infection, cancer and autoimmune disease. Avila is funded by leading venture capital firms: Abingworth, Advent Venture Partners, Atlas Venture, Novartis Option Fund, and Polaris Venture Partners. For additional information, please visit http://www.avilatx.com/

Source

AASLD: Library of Slides and Posters

Coverage of the
61st Annual Meeting of the American
Association for the Study of Liver Diseases (AASLD 2010)
October 29 - November 2, 2010, Boston, MA


Library of Slides and Posters

Efficacy and Safety of TMC435 in Combination With Peginterferon a-2a and Ribavirin in Treatment-naïve Genotype-1 HCV Patients: 24-Week Interim Results from the PILLAR Study
M Fried and others. AASLD 2010.

In vitro studies investigating the mechanism of interaction between TMC435 and hepatic transporters
M Huisman and others. AASLD 2010.

Virologic analysis of genotype-1-infected patients treated with once-daily TMC435 during the Optimal Protease inhibitor Enhancement of Response to TherApy (OPERA)-1 study
O Lenz and others. AASLD 2010.

A Phase IIa, open-label study to assess the antiviral activity of TMC435 monotherapy in patients infected with HCV genotypes 2–6
C Moreno and others. AASLD 2010.

Pharmacokinetic-pharmacodynamic analyses of TMC435 in patients infected with hepatitis C virus genotypes 2–6
V Sekar and others. AASLD 2010.

4-Week Virologic Response and Safety of ABT-450 Given with Low-dose Ritonavir (ABT-450/r) First As 3-Day Monotherapy Then in Combination with Pegylated Interferon Alpha-2a and Ribavirin (SOC) in Genotype 1 (GT1) HCV-infected Treatment-naïve Subjects
E Lawitz and others. AASLD 2010.

Initial Antiviral Activity of the HCV NS3 Protease Inhibitor ABT-450 When Given with Low-dose Ritonavir as 3-Day Monotherapy: Preliminary Results of Study M11-602 in Genotype 1 (GT1) HCV-infected Treatment-naïve Subjects
E Lawitz and others. AASLD 2010.

HCV RESPOND-2 Final Results High Sustained Virologic Response Among Genotype 1 Previous Non-Responders and Relapsers to Peginterferon/Ribavirin when Re- Treated with Boceprevir Plus PEGINTRON (Peginterferon alfa-2b)/Ribavirin
B Bacon and others. AASLD 2010.

Boceprevir Combined with Peginterferon alfa-2b/Ribavirin for Treatment-Naïve Patients with HCV Genotype 1
F Poordad and others. AASLD 2010.

Frequencies of Resistance-Associated Amino Acid Variants Following Combination Treatment with Boceprevir Plus PEGINTRON (PegInterferon Alfa-2b)/Ribavirin in Patients With Chronic Hepatitis C (CHC), Genotype 1 (G1)
J Vierling and others. AASLD 2010.

Hemoglobin Decline During Lead-in Phase as an Early Predictor of Anemia After the Addition of Boceprevir: A Retrospective Analysis of HCV SPRINT-1
F Poordad and others. AASLD 2010.

Response-Guided Therapy with Boceprevir + Peginterferon alfa-2b/Ribavirin for Treatment-Naïve Patients with Hepatitis C Virus Genotype 1 Was Similar to a 48-Wk Fixed-Duration Regimen with Boceprevir + Peginterferon alfa-2b/Ribavirin in SPRINT-2
J Bronowicki and others. AASLD 2010.

Strong antiviral activity and safety of IFN-sparing treatment with the protease inhibitor BI 201335, the HCV polymerase inhibitor BI 207127, and ribavirin, in patients with chronic hepatitis C: the SOUND-C1 trial
S Zeuzem and others. AASLD 2010.

Virological response and safety of 4 weeks’ treatment with the protease inhibitor BI 201335 combined with 48 weeks of peginterferon alfa 2a and ribavirin for treatment of HCV GT-1 patients who failed peginterferon/ribavirin
T Berg and others. AASLD 2010.

Genotypic and phenotypic analysis of the NS5B polymerase region from viral isolates of HCV chronically infected patients treated with BI 207127 for 5 days’ monotherapy
L Lagace, and others. AASLD 2010.

BMS-790052, a First-in-Class Potent Hepatitis C Virus NS5A Inhibitor, Demonstrates Multiple-Dose Proof-of-Concept in Subjects With Chronic GT1 HCV Infection
R Nettles and others. AASLD 2010.

Coadministration of BMS-790052 and BMS-650032 Does Not Result in a Clinically Meaningful Pharmacokinetic Interaction in Healthy Subjects
M Bifano and others. AASLD 2010.

Pipeline Asset Update for BMS-790052 (NS5A inhibitor) and BMS-650032 (NS3 inhibitor)
Btistol-Myers Squibb Company. AASLD 2010.

Combination Therapy With BMS-790052 and BMS-650032 Alone or With Pegylated Interferon and Ribavirin (pegIFN/RBV) Results in Undetectable HCV RNA Through 12 Weeks of Therapy in HCV Genotype 1 Null Responders
A Lok and others. AASLD 2010.

BMS-824393 Is a Potent Hepatitis C Virus NS5A Inhibitor With Substantial Antiviral Activity When Given as Monotherapy in Subjects With Chronic G1 HCV Infection
R Nettles and others. AASLD 2010.

Safety and Antiviral Activity of MK-5172, a Novel HCV NS3/4a Protease Inhibitor with Potent Activity Against Known Resistance Mutants, in Genotype 1 and 3 HCV-Infected Patients
A Petry and others. AASLD 2010.

Safety, Tolerability, and Pharmacokinetics after Single and Multiple Doses of MK-5172, a Novel HCV NS3/4a Protease Inhibitor with Potent Activity Against Known Resistance Mutants, in Healthy Subjects
A Petry and others. AASLD 2010.

High Correlation Between Week 4 and Week 12 as the Definition for Null Response to Peginterferon alfa (PEG) Plus Ribavirin (R) Therapy: Results From the IDEAL Trial
F Poordad and others. AASLD 2010.

Impact of PegIntron (PEG) Maintenance Therapy (MT) on Fibrosis Biomarkers (FibroTest [FT]/FibroSURE) in Prior Nonresponders With METAVIR Fibrosis Scores (MFS) of F2/F3: Final Results From the EPIC3 Program
T Poynard and others. AASLD 2010.

The Effect of Treatment Group, HCV Genotype, and IL28B Genotype on Early HCV Viral Kinetics in a Phase 2a Study of PEG-Interferon Lambda (pegIFNë) in Hepatitis C Patients
J Freeman and others. AASLD 2010.

Pegylated Interferon Lambda (pegIFNë) Phase 2 Dose-Ranging, Active-Controlled Study in Combination With Ribavirin (RBV) for Treatment-Naive HCV Patients (Genotypes 1, 2, 3, or 4): Safety, Viral Response, and Impact of IL28B Host Genotype Through Week 12
A Muir and others. AASLD 2010.

Pharmacokinetics of PEG-Interferon Lambda (pegIFNë) Following Fixed Dosing in Treatment-Naive Hepatitis C Subjects (Single-Dose Interim Data From a Dose-Ranging Phase 2a Study)
K Byrnes-Blake and others. AASLD 2010.

Sustained Viral Response (SVR) Rates in Genotype 1 Treatment-naïve Patients with Chronic Hepatitis C (CHC) Infection Treated with Vaniprevir (MK-7009), a NS3/4a Protease Inhibitor, in Combination with Pegylated Interferon Alfa-2a and Ribavirin for 28 Days
M Manns and others. AASLD 2010.

Genotypic and Phenotypic Analysis of HCV NS5A Inhibitor Resistance Variants: Correlations Between In Vitro and In Vivo Observations
M Gao and others. AASLD 2010.

Impaired Fasting Glucose Is Associated With Lower Rates of Sustained Virologic Response (SVR) in Patients With Genotype 1 Chronic Hepatitis C (CHC): Retrospective Analysis of the IDEAL Study
M Sulkowski and others. AASLD 2010.

Analysis of Site Performance in Academic and Community-Based Centers in the IDEAL Study
J Jou and others. AASLD 2010.

Baseline, Donor, and On-treatment Predictors of Sustained Virologic Response in Patients Treated for Recurrent Hepatitis C Following Orthotopic Liver Transplant: Subanalysis of the PROTECT Study
F Gordon and others. AASLD 2010.

Chronic Hepatitis C (HCV) Infections and the Risk of Depression and Other Adverse Events
J McCombs and others. AASLD 2010.

Sensitive Detection of Y448H NS5B Mutant Viruses in Patients Infected with Genotype 1a and 1b HCV
A Bae and others. AASLD 2010.

Safety, Pharmacokinetics, and Antiviral Activity of Single Oral Doses of the HCV NS3 Protease Inhibitor GS-9256
R Goldwater and others. AASLD 2010.

Enhanced in Vitro Antiviral Activity and Suppression of Resistance by Combining GS-9256, A Novel Protease Inhibitor, With GS-9190, a Non-Nucleoside NS5B Inhibitor
H Mo and others. AASLD 2010.

Antiviral Response and Resistance Analysis of Treatment-Naïve HCV Infected Subjects Receiving Single and Multiple Doses of GS-9190
J Harris and others. AASLD 2010.

Nonclinical Profi le and Phase I Results in Healthy Volunteers of the Novel and Potent HCV NS5A Inhibitor GS-5885
J Link and others. AASLD 2010.

Characterization of HCV Resistance from Single and Multiple Dose Clinical Trials of GS-9256, a Novel NS3 Protease Inhibitor
K Wong and others. AASLD 2010.

Three-Day, Dose-Ranging Study Of The HCV NS3 Protease Inhibitor GS-9451
E Lawitz and others. AASLD 2010.

Dual, Triple, and Quadruple Combination Treatment with a Protease Inhibitor (GS-9256) and a Polymerase Inhibitor (GS-9190) alone and in Combination with Ribavirin(RBV) or PegIFN/RBV for up to 28 days in Treatment Naïve, Genotype 1 HCV Subjects
S Zeuzem and others. AASLD 2010.

Source

November 27, 2010

Living Donor Information: Liver

Published: Feb. 12, 2010
Updated: Feb. 12, 2010

When a family member has liver disease and their liver fails, it can be stressful both for the patient and their family. Talking with family members, your doctors and nurses, a social worker, counselor, or clergy person may help you sort out your feelings and worries.

The information below is about donating a part of your liver to a family member. You should discuss this with your family members as well as the doctors and nurses you will see at the Transplant Clinic.

When is it time to think about donation?

Usually someone must lose 80 to 90 percent or more of their liver function before they need liver replacement therapy. There is no hepatic dialysis, so patients with progressive, acute, or chronic liver failure either become transplanted or die. Sometimes liver failure happens suddenly. It also may happen slowly over many years. Either way the patient and their doctor will discuss the best options for them.

Who can be a living donor?

Living liver donors must be over 18 years old. Donors must be healthy, less than 50 years of age, and must have a compatible blood type. The donor must meet minimum hepatic volume requirements for the recipient (they must match in size).

The most common donors are related members of the family. These people are usually parents, children, or brothers or sisters of the person needing the transplant. Sometimes other family members, like grandparents, cousins, aunts, or uncles can be a donor.

In some cases, a husband or wife may be considered as a donor. Other non-related persons who have a very close emotional bond to the recipient are sometimes appropriate for donation of part of their liver.

How will I know if it’s okay for me to be a donor?

After the blood typing is done we will know if you are a compatible match with your relative. Then we will talk with you in detail about being a donor.

First, you must decide if you want to be evaluated as a donor. If you do, then we will do several tests to make sure you are healthy and it is safe for you to donate part of your liver. This testing will take about two or three days, but you do not have to stay in the hospital for the tests. You will have these tests done: Blood samples (if compatible blood types), chest x-ray, EKG, volumetric abdominal CT scan, liver biopsy, and arteriogram.

You will see these people:

■ Hepatologist -- a liver specialist who will do a physical exam and talk with you about your family and medical history. The hepatologist may request a liver biopsy to be done after he has examined you.

■ Transplant nurse -- Will talk with you about the surgery and your hospital stay.

■ Social worker or psychiatrist -- Will talk with you about your feelings and concerns.

If all of these tests and evaluations show it is safe for you to continue we will schedule the last day of tests. You will be evaluated by a surgeon, and we will schedule an arteriogram. This is an x-ray test used to look at the blood vessels to the liver.

In this test a small tube is inserted into a blood vessel in your groin area and passed up to the blood vessels going to your liver. A small amount of dye is injected and pictures of the blood supply to your liver are made. You will need to remain in an observation area for up to six hours after this test is completed. If everything is okay with this test then we can schedule a transplant. Sometimes we may need to do some other tests, before the arteriogram.

Are there risks to me if I donate a part of my liver?

With any surgery there are risks of bleeding or infections. There is also some risk associated with being put to sleep for surgery. The risk of death from this surgery is less than 1 percent. The reason we do lots of tests on possible donors is to see that they are healthy and that it is safe for them to donate. We want to be as sure as we can that donating a part of your liver now is not likely to cause you harm in the future.

How much will this cost me?

The tests, surgery, hospital stay, and your return visit will not cost you. They are charged to the recipient’s insurance or Medicare. Your relative’s insurance or Medicare will not cover your time away from work or travel. Your only direct expense may be for some discharge medicines, such as pain medication and antibiotics. These usually cost less than $75.

Are there benefits to me as a donor?

Many people feel donating a part of their liver is rewarding and satisfying. It is quite normal to have some concerns over donating a part of your liver. Often talking over your feelings and concerns with your family members and the medical staff can ease those concerns and worries. You may find it helpful to talk with someone who has donated an organ to a family member. Ask the transplant nurse if that is possible.

What if I decide not to donate part of my liver?

Deciding to donate a part of your liver should be your decision without family pressure. It is up to you to decide if donating is right for you. You need to consider all the facts, the risks, and the benefits to decide what is right for you. Also the person with liver failure who needs a transplant has a right to decide that they do not want a transplant or they do not want to ask you to donate.

Who else can donate a part of their liver?

Sometimes other family members or friends ask if they can donate a part of their liver. We do evaluate other family members such as wives, husbands, or more distant relatives. Talk with your transplant nurse or doctor if you are interested in this option.

Source

New HCV Therapies on the Horizon

Clinical Microbiology and Infection
DOI: 10.1111/j.1469-0691.2010.03430.x
Copyright © 2010 European Society of Clinical Microbiology and Infectious
Accepted Article (Accepted, unedited articles published online for future issues)

Author Information
Medizinische Klinik 1, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany

*Correspondence: Christoph Sarrazin,
*Correspondence: Corresponding author: Christoph Sarrazin, MD Medizinische Klinik 1 Klinikum der J.W. Goethe-Universität Theodor-Stern-Kai 7 60590 Frankfurt am Main, Germany Phone: +496963015122; Fax: +4969630183112 Email: sarrazin@em.uni-frankfurt.de

Abstract

Improved understanding of the hepatitis C virus (HCV) life-cycle has led to the discovery of numerous potential targets for antiviral therapy. HCV polyprotein processing and replication have been identified as the most promising viral targets. However, viral entry and fusion, RNA translation, virus assembly and release and several host cell factors may provide alternative attractive targets for future anti-HCV therapies.

Inhibitors of the HCV NS3/4A protease are currently the most advanced in clinical development. Monotherapy with protease inhibitors revealed high antiviral activity but was associated with a frequent selection of resistant HCV variants, often resulting in viral breakthrough. However, there is encouraging evidence from phase 2/3 trials, indicating that the addition of a protease inhibitor (e.g. telaprevir and boceprevir) to pegylated interferon-alfa/ribavirin substantially improves sustained virologic response rates in both treatment-naïve and -experienced patients with HCV genotype 1.

Nucleos(t)ide inhibitors of the HCV NS5B polymerase have shown variable antiviral activity against different HCV genotypes but seem to have a higher genetic barrier to resistance compared to protease inhibitors. In addition, several allosteric binding sites have been identified for non-nucleoside inhibitors of the NS5B polymerase. However, development of a substance with high antiviral activity and a high genetic barrier to resistance seems to be difficult. Among the different host-cell targeting compounds in early clinical development, cyclophilin-inhibitors have shown the most promising results.

Although advances have also been made towards the improvement of interferons, combinations of antiviral agents with different mechanisms of action may lead to the eventual possibility of interferon-free regimens.

Source

AASLD: From Podium to Practice: Updates in HCV Treatment

Source: CCO Official Conference Coverage of the 2010 Annual Meeting of the American Association for the Study of Liver Diseases*

*CCO is an independent medical education company that provides state-of-the-art medical information to healthcare professionals through conference coverage and other educational programs

Capsule Summaries
Disclaimer: The materials published on the Clinical Care Options Sites reflect the views of the reviewers or authors of the CCO material, not those of Clinical Care Options, LLC, the CME provider, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
 

November 26, 2010

Specialists Boost HCV Treatment Rates in Veterans

By Dave Levitan

NEW YORK (Reuters Health) Nov 23 - HCV treatment rates are low among veterans, but consultation with a specialist can drastically increase the likelihood of therapy.

"The study supports previous findings of low treatment rates reported in single or few centers in the VA, and extends the findings to the entire national VA system," said the new study's lead author Dr. Jennifer Kramer, of the Michael E. DeBakey Veterans Affairs Medical Center in Houston, in an e-mail to Reuters Health.

Dr. Kramer and colleagues used retrospective data from the Veterans Affairs hepatitis C virus Clinical Case Registry to evaluate 29,695 patients diagnosed with the virus between 2003 and 2004. Overall, only 4,213 patients (14.2%) received treatment. The study's results were published online ahead of print November 9th in the American Journal of Gastroenterology.

Several patient, provider and facility-related factors influenced whether or not a patient received treatment. Black patients had an adjusted odds ratio for receiving treatment of 0.52 compared with white patients (p<0.0001). Patients older than 65 also had a significantly lower chance of being treated (OR, 0.32; p<0.0001) compared to those under 45 years, as did male patients (OR, 0.53; p<0.0001).

Patients with cirrhosis were significantly more likely to receive treatment (OR, 2.11; p<0.0001), and those with alcohol or other drug abuse, anxiety, post-traumatic shock disorder or severe depression were less likely.

"According to our findings, seeing a specialist consultant was the most important predictor for receipt of hepatitis C virus treatment," Dr. Kramer said, with an OR of 9.34.

"Clinical reminders for timely referral and the availability of adequate capacity of trained specialists are some of the basic needs for managing this disease."

Dr. Kramer said that the generally low treatment rates in the VA system could be improved by interventions targeting factors that are considered as barriers to treatment; these include depression and alcohol abuse. Her group is in the early stages of a new study of a "collaborative depression management" program in four VA hospitals that Dr. Kramer hopes will help remove one of the modifiable barriers to hepatitis C treatment.

Am J Gastroenterol. Posted online November 9, 2010. Abstract

Source

Induction Immunosuppression Improves Long-Term Graft and Patient Outcome in Organ Transplantation: An Analysis of United Network for Organ Sharing Registry Data

Transplantation. 2010 Nov 4. [Epub ahead of print]

Cai J, Terasaki PI.

Terasaki Foundation Laboratory, Los Angeles, CA.

Abstract

BACKGROUND.: Induction agents have been shown to reduce the rate of acute rejection. They have not been clearly shown to improve graft and patient survival. METHODS.: United Network for Organ Sharing registry data were analyzed to show the status of induction therapy in the United States and to determine the effect of induction therapy on long-term graft and patient survival. RESULTS.: Since establishment of the United Network for Organ Sharing renal transplant registry, there have been three distinct eras of induction regimen: (1) the low-induction, old antibody era, 1987 to 1993, when antilymphocyte globulin and muromonab-CD3 were the major agents; (2) a high-induction, transitional era, 1994 to 2002, when basiliximab (1998), daclizumab (1998), and rabbit antithymocyte globulin (rATG; 1999) replaced antilymphocyte globulin and muromonab-CD3, with maintenance agents also used; (3) the high-induction, modern antibody era, 2003 to present, with most patients receiving rATG, basiliximab, daclizumab, or alemtuzumab (2003). Induction recipients had higher graft and patient survival rates than nonrecipients in all categories of organ transplant. The improvement was statistically significant in kidney, liver, and lung transplants, although liver and lung recipients had a lower percentage of patients receiving induction than did kidney patients. Kidney transplant recipients on alemtuzumab with steroids had the lowest risk of graft failure, followed by those on alemtuzumab alone, rATG with steroids, rATG alone, and then basiliximab with steroids. Improvement was not statistically significant with daclizumab (alone or with steroids), basiliximab alone, or steroids alone. CONCLUSION.: Induction immunosuppression improved graft and patient outcome for most organ transplants. Depleting agents (alemtuzumab and rATG)-especially in combination with steroids-seem to be more efficient in preventing renal graft failure than nondepleting agents (basiliximab and daclizumab).

PMID: 21057388 [PubMed - as supplied by publisher]

Source

Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma: Radiologic–pathologic correlation

Articles in Press

Ahsun Riaz 1, Khairuddin Memon 1, Frank H. Miller 1, Paul Nikolaidis 1, Laura M. Kulik 2, Robert J. Lewandowski 1, Robert K. Ryu 1, Kent T. Sato 1, Vanessa L. Gates 1, Mary F. Mulcahy 3, Talia Baker 4, Ed Wang 5, Ramona Gupta 1, Ritu Nayar 6, Al B. Benson III 3, Michael Abecassis 4, Reed Omary 1, Riad Salem 14

Received 15 February 2010; received in revised form 1 October 2010; accepted 6 October 2010. published online 26 November 2010.
Uncorrected Proof

Background & Aims
We sought to study receiver-operating characteristics (ROC) of the European Association for the Study of the Liver (EASL), Response Evaluation Criteria in Solid Tumors (RECIST), and World Health Organization (WHO) guidelines for assessing response following locoregional therapies individually and in various combinations.

Methods
Eighty-one patients with hepatocellular carcinoma underwent liver explantation following locoregional therapies. Response was assessed using the EASL, RECIST, and WHO. Kappa statistics were used to determine inter-method agreement. Uni/multivariate logistic regression analyses were performed to determine the variables predicting complete pathologic necrosis. Numerical values were assigned to the response classes: complete response=0, partial response=1, stable disease=2, and progressive disease=3. Various mathematical combinations of the EASL and WHO were tested to calculate scores and their ROCs were studied using pathological examination of the explant as the gold standard.

Results
Median times (95% CI) to the WHO, RECIST, and EASL responses were 5.3 (4–11.5), 5.6 (4–11.5), and 1.3months (1.2–1.5), respectively. Kappa coefficients for WHO/RECIST, WHO/EASL, and RECIST/EASL were 0.78, 0.28, and 0.31, respectively. EASL response demonstrated significant odds ratios for predicting complete pathologic necrosis on uni/multivariate analyses. Calculated areas under the ROC curves were: RECIST: 0.63, WHO: 0.68, EASL: 0.82, EASL+WHO: 0.82, EASL×WHO: 0.85, EASL+(2×WHO): 0.79 and (2×EASL)+WHO: 0.85. An EASL×WHO Score of 1 had 90.2% sensitivity for predicting complete pathologic necrosis.

Conclusion
The product of WHO and EASL demonstrated better ROC than the individual guidelines for assessment of tumor response. The EASL×WHO scoring system provides a simple and clinically applicable method of response assessment following locoregional therapies for hepatocellular carcinoma.

Keywords: Hepatocellular carcinoma, Locoregional therapies, Imaging, Pathologic correlation

1 Department of Radiology, Northwestern University, Chicago IL, USA
2 Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL, USA
3 Department of Medicine, Division of Medical Oncology, Northwestern University, Chicago, IL, USA
4 Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, IL, USA
5 Department of Surgery, Section of Biostatistics, Northwestern University, Chicago, IL, USA
6 Department of Pathology, Northwestern University, Chicago, IL, USA

Corresponding author. Address: Interventional Oncology, Department of Radiology, 676N, St. Clair, Suite 800, Chicago, IL 60611, USA. Tel.: +1 312 695 6371; fax: +1 312 695 0654.

PII: S0168-8278(10)00910-4
doi:10.1016/j.jhep.2010.10.004
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

Source

IL-28B rs12979860 C/T allele distribution in patients with liver cirrhosis: Role in the course of chronic viral hepatitis and the development of HCC

Articles in Press

Carlo Fabris 1, Edmondo Falleti 2, Annarosa Cussigh 2, Davide Bitetto 1, Elisabetta Fontanini 2, Sara Bignulin 1, Sara Cmet 2, Ezio Fornasiere 1, Elisa Fumolo 1, Stefano Fangazio 3, Andrea Cerutti 3, Rosalba Minisini 3, Mario Pirisi 3, Pierluigi Toniutto 1

Received 23 January 2010; received in revised form 8 July 2010; accepted 17 July 2010. published online 26 November 2010.
Uncorrected Proof

Background & Aims
A single nucleotide polymorphism (rs12979860 C/T) 3kb upstream of the interleukin 28B (IL-28B) gene was shown to be associated with hepatitis C clearance. We verified whether this association also translates into a different genotype distribution at the end of the disease trajectory.

Methods
A RFLP-PCR technique was used to genotype 412 patients with cirrhosis due to hepatitis C (n=199), hepatitis B (n=75), alcohol (n=110) and other causes (n=28), of whom 256 underwent liver transplantation (OLT). Hepatocellular carcinoma (HCC) was demonstrated in the native liver of 85 OLT patients, 52 with viral cirrhosis, and 33 with non-viral cirrhosis. A group of 292 patients (235 HCV and 57 HBV positive) with mild chronic hepatitis and 344 healthy subjects served as controls.

Results
A significant difference (p=0.0005) was observed in IL-28B rs12979860 genotype frequencies between patients with viral cirrhosis (C/C=99, C/T=137, T/T=38) and those with non-viral cirrhosis (C/C=72, C/T=58, T/T=8). Patients with HCV related cirrhosis carried more frequently the T/T genotype in comparison to mild hepatitis C or HBV-related cirrhosis. IL-28B rs12979860 genotype frequencies were C/C=23, C/T=50, T/T=12 among OLT patients with cirrhosis complicated by HCC, and C/C=79, C/T=78, T/T=14 among patients with cirrhosis not complicated by HCC (p<0.005).

Conclusions
IL-28B rs12979860 C/T polymorphism T allele is more prevalent in patients with viral cirrhosis due to HCV in comparison to other aetiologies and to patients with mild chronic hepatitis C. Among OLT patients, carriage of this allele seems to augment the risk of developing HCC.

Keywords: Interleukin 28B, Hepatitis C, Liver cirrhosis, Hepatocellular carcinoma, Genetic polymorphisms

Abbreviations: HBV, hepatitis B virus, HCV, hepatitis C virus, HCC, hepatocellular carcinoma, IFN, interferon, SVR, sustained viral response, IL, interleukin, OLT, liver transplantation

1 Medical Liver Transplantation Unit, Internal Medicine, DPMSC, University of Udine, Italy
2 Laboratory Medicine, University of Udine, Italy
3 Department of Clinical and Experimental Medicine, University of Eastern Piedmont “A. Avogadro”, Novara, Italy

Corresponding author. Address: Internal Medicine, Medical Liver Transplantation Unit, University of Udine, Piazzale S.M. Della Misericordia 1, 33100 Udine, Italy. Tel.: +39 0432559802; fax: +39 043242097.

PII: S0168-8278(10)00807-X
doi:10.1016/j.jhep.2010.07.019
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

Source

Etiology-related determinants of liver stiffness values in chronic viral hepatitis B or C

Articles in Press

Mirella Fraquelli 1, Cristina Rigamonti 2, Giovanni Casazza 3, Maria Francesca Donato 2, Guido Ronchi 2, Dario Conte 1, Mariagrazia Rumi 2, Pietro Lampertico 2, Massimo Colombo 2

Received 22 January 2010; received in revised form 23 July 2010; accepted 23 July 2010. published online 26 November 2010.
Uncorrected Proof

Abstract

Background & Aims
Transient elastography (TE) has gained popularity for the non-invasive assessment of severity of chronic viral hepatitis, but a comprehensive evaluation of the factors that might account for discrepancy in diagnostic accuracy between TE and the standard of care liver biopsy (LB) is still needed.

Methods
Patients with chronic hepatitis-B (HBV, n=104) or -C (HCV, n=453) underwent percutaneous LB concomitantly with TE (FibroScan®; Echosens, Paris, France). Liver cell necroinflammatory activity (A) and fibrosis (F) were assessed by METAVIR. Perisinusoidal fibrosis was rated with a 0–3 score. Determinants of TE results were investigated by a linear regression model whereas discordance between TE and LB results was assessed by logistic regression.

Results
Fibrosis (p<0.0001) and liver cell necroinflammatory activity (p<0.0001) were independently associated with TE results in both HBV and HCV patients, whereas steatosis (p<0.0001) was independently associated with TE in HCV only. Fibrosis overestimation was predicted by severe/moderate necroinflammatory activity in HBV and by older age (41–60 or>60years vs.<40), >2 UNL AST and>2 UNL GGT, as well as severe/moderate necroinflammatory activity and severe/moderate steatosis in HCV. In the latter patients, however, moderate/severe necroinflammatory activity and steatosis were the only independent predictors of fibrosis overestimation.

Conclusions
Fibrosis and necroinflammatory activity are the main determinants of TE in chronic viral hepatitis. Since TE staging of Fibrosis is influenced by necroinflammatory activity and steatosis, a diagnostic LB is deemed necessary for a reliable intra-patient TE monitoring of the course of viral hepatitis.

Abbreviations: TE, transient elastography, LB, liver biopsy, CLD, chronic liver disease, A, necroinflammatory activity, F, fibrosis stage, BMI, body mass index, HBV, hepatitis B virus, HCV, hepatitis C virus, ALT, alanine aminotransferase, AST, aspartate aminostransferase, GGT, gamma-glutamyltranspeptidase, HBsAg, hepatitis B surface antigen, US, ultrasound, kPa, kilopascal, IQR, interquartile range, UNL, upper normal limit, OR, odds ratio, 95% CI, 95% confidence interval

Keywords: Transient elastography, Liver biopsy, Liver fibrosis, Hepatitis B, Hepatitis C

1 Second Division of Gastroenterology, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy
2 First Division of Gastroenterology, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, Milano, Italy
3 Department of Statistic and Biometry, University of Milan, Milano, Italy

Corresponding author. Address: Second Division of Gastroenterology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy. Tel.: +39 02 55033445; fax: +39 02 55033644.

PII: S0168-8278(10)00805-6
doi:10.1016/j.jhep.2010.07.017
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

Source

November 25, 2010

The ministransplant procedure in liver transplantation

Acta Gastroenterol Belg. 2010 Jul-Sep;73(3):367-9.

Donataccio M, Dalle Ore G, Donataccio D.

Liver Transplantation Unit, Ospedale Civile Maggiore, Verona, Italy. matteodonataccio@yahoo.it

Abstract

In order to ameliorate early recovery after liver transplantation a reduction of invasiveness of the abdominal incision has been tested and compared with more extended incisions. This approach named "minitransplant procedure" resulted in better early and late outcome results irrespective of preoperative patients' risk factors as previous upper abdominal surgery, Body Mass Index and Model of End Stage Liver Disease score.

PMID: 21086940 [PubMed - in process]

Source

Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation

Clin Transplant. 2010 Nov 16. doi: 10.1111/j.1399-0012.2010.01350.x. [Epub ahead of print]

Moini M, Hoseini-Asl MK, Taghavi SA, Sagheb MM, Nikeghbalian S, Salahi H, Bahador A, Motazedian M, Jafari P, Malek-Hosseini SA.

Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences Shiraz Organ Transplant Center, School of Medicine, Shiraz University of Medical Sciences Department of Surgery, School of Medicine, Shiraz University of Medical Sciences School of Medicine, Shiraz University of Medical Sciences Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Moini M, Hoseini-Asl MK, Taghavi SA, Sagheb MM, Nikeghbalian S, Salahi H, Bahador A, Motazedian M, Jafari P, Malek-Hosseini SA. Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation.
Clin Transplant 2010 DOI: 10.1111/j.1399-0012.2010.01350.x.
© 2010 John Wiley & Sons A/S. Abstract:  The current policy for organ allocation in liver transplantation is to give priority to the sickest patients mostly using model for end-stage liver disease (MELD) score in ranking. However, other factors as serum sodium may be of value in predicting early mortality. In this single-center study, patients with cirrhosis over age 14 on the liver transplant wait-list from September 1998 to June 2007 were followed for six months from the time of listing to evaluate the value of hyponatremia on mortality. Of 612 listed patients, 51 were transplanted who were excluded from survival analysis and 55 died without transplantation within the first three months. The numbers of transplanted and dead patients during months 3-6 were 29 and 24, respectively. Both MELD score and serum sodium at the time of listing were independent predictors of early mortality. On bivariate analysis, serum sodium of <130 mEq/L beside MELD was a significant predictor of mortality within 90 and 180 d. Serum sodium level <135 mEq/L masked the difference in mortality between patients with refractory and non-refractory ascites. Serum sodium level of <130 mEq/L and an increased MELD score are significant predictors of early mortality in patients listed for liver transplantation.

© 2010 John Wiley & Sons A/S.

PMID: 21077951 [PubMed - as supplied by publisher]

Source

Liver transplantation in HIV infected patients: indications and results

Acta Gastroenterol Belg. 2010 Jul-Sep;73(3):380-2.

Duclos-Vallée JC.

AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 94800 Villejuif, France. jean-charles.duclos-vallee@pbr.aphp.fr

Abstract

Liver transplantation (LT) is now feasible in HIV infected patients. To date, criteria of liver transplantation are no different from the other indications of liver transplantation; however an undetectable HIV viral load at the time of liver transplantation is desirable goal. History of opportunistic infections and CD4+ count < 100/mL do not constitute exclusion criteria. Long-term outcomes for HBV/HIV are excellent. Outcomes for HCV/HIV coinfected patients are more variable because of potentially severe recurrence on the liver graft. More effective antiviral therapy at an early stage post LT is required.

PMID: 21086943 [PubMed - in process]

Source

November 24, 2010

Pharmasset Reports Fiscal Year End 2010 Financial Results

PRINCETON, N.J., Nov. 23, 2010 /PRNewswire-FirstCall/ -- Pharmasset, Inc. (Nasdaq: VRUS), a clinical stage pharmaceutical company committed to discovering, developing, and commercializing novel drugs to treat viral infections, today reported financial results and operational highlights for the fiscal year ended September 30, 2010. At fiscal year end Pharmasset held $127.1 million in cash and cash equivalents.

Pipeline Update and 2010 highlights

RG7128

Phase 2b PROPEL and JUMP-C trials

During February 2010, dosing in the Phase 2b PROPEL study was completed. Four hundred and eight treatment-naïve, genotypes 1 or 4 hepatitis C virus (HCV)-infected patients (cirrhotic and non-cirrhotic) were enrolled. The trial is evaluating the dose and duration of treatment of RG7128 in combination with pegylated interferon and ribavirin (SOC).

In November 2010 at the AASLD meeting, Roche presented results from a 12 week interim analysis of the PROPEL study. The results presented included:

• RG7128 1000 mg BID in combination with SOC for 12 weeks achieved a high rate of complete Early Virologic Response (cEVR; <15 IU/mL) of 83% with no on-treatment viral breakthrough

• The safety and tolerability of RG7128 1000 mg BID with SOC were comparable to placebo/SOC with no renal or hematologic safety signals, and a discontinuation rate similar to placebo/SOC

• No drug resistance was observed in 367 patients treated with up to 12 weeks of RG7128

In early May 2010, Roche completed enrollment of 168 treatment naive, genotypes 1 or 4 HCV-infected patients in its JUMP-C trial.

An amendment to the PROPEL and JUMP-C trial has been implemented by Roche which allows patients who were initially randomized to the placebo/SOC arm and who are non-responders to receive open label RG7128 1000mg BID in combination with SOC for 24 weeks, followed by an additional 24 weeks of SOC.

In addition, Roche is planning to initiate a Phase 2b study of RG7128 in combination with SOC in patients with HCV genotypes 2 or 3 during the first half of 2011. Roche is also planning to initiate a Phase 3 program for RG7128 during 2011 and plans to submit a marketing application for RG7128 to one or more regulatory authorities in 2013.

PSI-7977

In January 2010, Pharmasset initiated a 28 day phase 2a dose-finding trial with PSI-7977 in combination with SOC. The trial enrolled 63 treatment-naïve, genotype 1 HCV infected patients who received either 100mg QD, 200mg QD, 400mg QD or placebo in combination with SOC for 28 days. In May 2010, we reported interim results from the trial which demonstrated that PSI-7977 was generally safe and well tolerated, as well as exhibiting potent antiviral activity (i.e. 94% RVR with 200 mg QD in combination with SOC). All patients receiving active PSI-7977 demonstrated continuous and substantial declines in HCV RNA with no viral breakthrough during the 28 days of therapy at any dose. Final results were reported in three posters at AASLD 2010 (Abstracts 815, 806, 1861).

In August 2010, we initiated a phase 2b dose-finding trial with PSI-7977 for 12 weeks in combination with SOC. The trial is expected to enroll approximately 125 treatment naïve, genotype 1 HCV-infected patients who will receive either 200mg QD, 400mg QD or placebo in combination with SOC for 12 weeks, followed by 12 weeks or 36 weeks of SOC alone. A fourth arm has completed enrollment of 25 treatment naïve, genotypes 2 or 3 HCV infected patients who will receive 400mg QD PSI-7977 in combination with SOC for 12 weeks only. We anticipate reporting preliminary safety results from this genotype 2/3 arm in the first quarter 2011 and SVR12 in the second quarter 2011.

In August 2010, Pharmasset received fast track designation from the US Food and Drug Administration (FDA) for PSI-7977 for the treatment of chronic hepatitis C (HCV) infection.

We are planning to initiate a Phase 2b study of PSI-7977 in combination with ribavirin administered with and without pegylated interferon in early December 2010. The study is expected to enroll approximately 40 treatment-naïve patients with HCV genotypes 2 or 3 and is designed to assess SVR with limited durations of pegylated interferon.

PSI-938

In April 2010, Pharmasset initiated a phase 1 single ascending dose trial with PSI-938, a purine nucleotide analog for HCV. In July 2010, we reported that single doses of PSI-938 ranging from 100mg to 800mg, and subsequently 1600mg, were generally safe and well tolerated and that a 7 day, multiple ascending dose trial had been initiated.

In October 2010, we reported positive preliminary antiviral data with PSI-938 demonstrating a median decline in HCV RNA of between 3.94 log10 to 4.64 log10 from baseline at all doses tested (100mg QD, 200mg QD, 300mg QD, 100mg BID). For the 16 subjects who received PSI-938 200mg QD or 300mg QD for 7 days, more than half (9 of 16) of the subjects on PSI-938 monotherapy achieved HCV RNA below the limit of detection (15 IU/mL) and 11 out of 16 patients achieved HCV RNA below the limit of quantification (43 IU/mL).

We are screening patients for Part 2 of a phase 1 study that includes the first combinations of a purine (PSI-938) and a pyrimidine (PSI-7977) nucleotide analog for the treatment of HCV. The cohorts within Part 2 are expected to evaluate PSI-938 QD, in the absence of interferon, as monotherapy and in combination with PSI-7977 QD. The primary objective of Part 2 of this study is to assess the safety, tolerability and pharmacokinetics of PSI-938 alone and in combination with PSI-7977 in the clinically-relevant setting of combination therapy for 14 days. The secondary objective of Part 2 of this study is to evaluate the short-term change in HCV RNA. Preliminary results are expected in the first quarter of 2011. Approximately forty patients are expected to be randomized into the study.

PSI-661

In October 2009, we nominated PSI-661, a purine nucleotide analog, for preclinical development. Our current plan is to submit an IND application, or its foreign equivalent, during the first quarter of 2011. We also plan to initiate a Phase 1 SAD study to assess the safety, tolerability, and pharmacokinetics of PSI-661 during the second quarter of 2011.

Financial Results

For the fiscal year ended September 30, 2010 Pharmasset reported revenues of $1.0 million, compared with revenues of $13.3 million for fiscal year 2009. The receipt of a $10.0 million milestone from Roche for the initiation of the phase 2b study with RG7128 led to higher reported revenues in fiscal year 2009.

Total costs and expenses for the fiscal year ended September 30, 2010 were $64.7 million compared to $65.9 million for the same period in 2009. The decrease in operating expenses for the fiscal year ended September 30, 2010 was primarily the result of discontinuing our clevudine program in April 2009. This reduction was mostly offset by increases in development costs for PSI-7977, PSI-938 and PSI-661.

Pharmasset reported a net loss of $66.1 million, or $2.13 per share for the fiscal year ended September 30, 2010, as compared to a net loss of $55.6 million, or $2.10 per share for the same period in 2009.

"Pharmasset had a very productive year, advancing all of its HCV clinical programs," stated Schaefer Price, President and Chief Executive Officer. "During the year, we advanced PSI-7977 through a Phase 2a trial and into a Phase 2b study in genotype 1, 2 or 3 patients. At the same time, we also reported very exciting data with our first purine nucleotide, PSI-938, and look forward to advancing this candidate into a 'nuc-nuc' combination trial this month. In 2011, Roche plans to start a Phase 3 program with RG7128 and we are anticipating reporting data throughout the year from our PSI-7977 Phase 2b trial and our 'nuc-nuc' combination trial."

Calendar Year 2011 Anticipated Milestones:

• Roche expects to initiate a phase 3 program with RG7128 in 2011

• Pharmasset expects to report 12 week safety from its ongoing phase 2b trial with PSI-7977 in genotype 2/3 patients in the first quarter 2011; SVR 12 data in the second quarter 2011

• Pharmasset expects to report the 12 week interim analysis from its PSI-7977 Phase 2b genotype 1 arms in the second quarter 2011

• Pharmasset expects to initiate a 24 week Phase 2b trial with PSI-7977 in the second quarter 2011

• Pharmasset expects to initiate Part 2 of a phase 1 study with PSI-938 alone and in combination with PSI-7977 in the fourth quarter 2010; report preliminary results during the first quarter 2011

• Pharmasset expects to initiate a phase 2 study with PSI-7977 and PSI-938 in the second quarter 2011

• Pharmasset expects to initiate an interferon sparing trial in genotype 2/3 patients with PSI-7977 in the fourth quarter 2010

• Pharmasset plans to file an IND for PSI-661 in the first quarter 2011 and to initiate a phase 1 trial in the second quarter 2011

• Roche expects to initiate a phase 2 study with RG7128 in genotype 2/3 patients in the first half 2011

About Pharmasset

Pharmasset is a clinical-stage pharmaceutical company committed to discovering, developing, and commercializing novel drugs to treat viral infections. Pharmasset's primary focus is on the development of oral therapeutics for the treatment of hepatitis C virus (HCV). Our research and development efforts focus on nucleoside/tide analogs, a class of compounds which act as alternative substrates for the viral polymerase, thus inhibiting viral replication. We currently have four clinical-stage product candidates. RG7128, a cytosine nucleoside analog for chronic HCV infection, is in two Phase 2b clinical studies in combination with Pegasys(R) plus Copegus(R) and is also in the INFORM studies, the first series of studies designed to assess the potential of combinations of small molecules without Pegasys(R) and Copegus(R) to treat chronic HCV. These clinical studies are being conducted through a strategic collaboration with Roche. Our other clinical stage HCV candidates include PSI-7977, an unpartnered uracil nucleotide analog that has recently initiated dosing in a Phase 2b study in HCV genotype 1, 2, and 3, and PSI-938, an unpartnered guanosine nucleotide analog which recently completed a 7-day monotherapy study. We also have in our pipeline an additional purine nucleotide analog, PSI-661, in advanced preclinical development.

Pegasys(R) and Copegus(R) are registered trademarks of Roche.

Contact
Richard E. T. Smith, Ph.D.
VP, Investor Relations and Corporate Communications
Office +1 (609) 613-4181

Forward-Looking Statements

Pharmasset "Safe Harbor" Statement under the Private Securities Litigation Reform Act of 1995: Statements in this press release that are not historical facts are "forward-looking statements," that involve risks, uncertainties, and other important factors, including, without limitation, the risk of cessation or delay of any of the ongoing or planned clinical trials and/or our development of our product candidates, the risk that the results of previously conducted studies involving our product candidates will not be repeated or observed in ongoing or future studies involving our product candidates, the risk that our collaboration with Roche will not continue or will not be successful, and the risk that any one or more of our product candidates will not be successfully developed and commercialized. For a discussion of risks, uncertainties, and other important factors, any of which could cause our actual results to differ from those contained in the forward-looking statements, see the section entitled "Risk Factors" in our Annual Report on Form 10-K for the fiscal year ended September 30, 2010 and our Quarterly Reports on Form 10-Q for the periods ended December 31, 2009, March 31, 2010 and June 30, 2010 filed with the Securities and Exchange Commission and discussions of potential risks, uncertainties, and other important factors in our subsequent filings with the Securities and Exchange Commission.

Source