Burlulipase

To evaluate the safety and efficacy of a novel microbial lipase (NM-BL) in a liquid formulation for the treatment of exocrine pancreatic insufficiency (EPI) in patients with cystic fibrosis (CF) in a phase IIa proof-of-concept study.

We conducted a double-blind, randomized, placebo controlled crossover study in patients with cystic fibrosis and exocrine pancreatic insufficiency. Adolescent and adult patients with CF were randomized to receive NM-BL or placebo for 1 week as replacement for their usual pancreatic enzyme formulation. They were subsequently crossed-over to the alternate study treatment. The coefficient of fat absorption was evaluated as the primary endpoint. Symptoms and adverse events were evaluated as secondary endpoints.

A total of 35 patients were randomized into the study and 22 patients completed both treatment periods. During treatment with NM-BL, the coefficient of fat absorption was significantly greater (72.7%) compared with placebo (53.8%) with a difference between groups of 18.8% (P < .001). Subjective assessment of stool fat and stool consistency also improved under treatment with NM-BL. Adverse events were mostly gastrointestinal in nature and were more common in the group receiving NM-BL.

Currently available pancreatic enzyme products are limited because of the lack of liquid formulations and being largely porcine based. The novel microbial lipase NM-BL was safe and effective in this short term trial. The trial provided clinical proof-of-concept for this novel microbial lipase as a treatment for EPI in CF. A larger phase 2 dose ranging trial is warranted.

ClinicalTrials.gov: NCT01710644.

To investigate the effects of H2-Bl gene on biological behaviour of mouse vascular smooth muscle cells (VSMCs) including apoptosis, proliferation and anti-cytolysis to peripheral blood mononuclear cells (PBMCs), then speculate the possible mechanism of immunological rejection after heart transplantation in maternal-fetal immune tolerance.

The mouse VSMC were transfected with 0.5 mg/L of pEGFP-N1 plasmid vector, 0.5 mg/L of pEGFP-N1-H2B1 plasmid vector and 1.0 mg/L of pEGFP-N1-H2B1 plasmid vector, respectively. The efficiency of transfection was detected, and the H2-Bl mRNA level, the apoptosis, the proliferation and cytotoxicity of VSMCs were also investigated at 24 h, 48 h and 72 h, respectively.

Expression of the H2-Bl gene was determined by real time quantitative PCR. Expressions of the H2-Bl in experimental groups were higher than that of the control group (P<0.001). VSMC apoptosis was observed after 24 h in the 0.5 mg/L and 1.0 mg/L H2-Bl experimental groups compared with control group (P<0.05, P<0.001, respectively). VSMC proliferation was also inhibited in the 0.5 mg/L and 1.0 mg/L H2-Bl gene groups at 24 h and 72 h (P<0.05, P<0.01, respectively). The cytotoxicity of PBMC in the 0.5 mg/L and 1.0 mg/L H2-Bl gene groups at 24 h was lower than the control group (P<0.005, P<0.001, respectively).

Transfection of pEGFP-N1-H2B1 plasmid to mouse VSMC causes the over expression of H2-Bl mRNA, induces the apoptosis, inhibits the proliferation and attenuates the cytotoxicity of PBMC, leading to immune tolerance.