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Biomedical subjects

J P Baker

Publications and source records attributed to J P Baker.

At least 19 recordsLinked to original sources
PubMed2005

A randomized, double-blind, placebo-controlled trial of CDP571, a humanized monoclonal antibody to tumour necrosis factor-alpha, in patients with corticosteroid-dependent Crohn's disease.

AIM: To evaluate CDP571, a humanized monoclonal antibody to tumour necrosis factor-alpha, for the treatment of corticosteroid-dependent Crohn's disease. METHODS: Patients with corticosteroid-dependent Crohn's disease (use of prednisolone 15-40 mg/day or budesonide 9 mg/day for at least 8 weeks, a previous failed attempt to discontinue corticosteroids within 8 weeks, and Crohn's Disease Activity Index score 150 points or less) were enrolled in a 16-week, randomized, double-blind, placebo-controlled trial. The patients received intravenous CDP571 (20 mg/kg at week 0 and 10 mg/kg at week 8) or placebo. Corticosteroid therapy was decreased following a predefined schedule. The primary efficacy end-point was the percentage of patients with corticosteroid-sparing [i.e. no disease flare (Crohn's Disease Activity Index score > or =220 points) and no longer requiring corticosteroid therapy] at week 10. The major secondary efficacy end-point was corticosteroid-sparing at week 16. RESULTS: Seventy-one patients received treatment. Corticosteroid-sparing was achieved by 19 of 39 (48.7%) CDP571 patients and 13 of 42 (40.6%) placebo patients (P = 0.452) at week 10, and by 18 of 39 (46.2%) CDP571 patients and seven of 32 (21.9%) placebo patients (P = 0.032) at week 16. CDP571 therapy was well-tolerated and the incidence of serious adverse events was similar to placebo. CONCLUSIONS: The CDP571 was effective for corticosteroid-sparing at week 16 but not week 10, and was well-tolerated in patients with corticosteroid-dependent Crohn's disease.

Adult↗
PubMed2001

An engineered human antibody to TNF (CDP571) for active Crohn's disease: a randomized double-blind placebo-controlled trial.

BACKGROUND & AIMS: We evaluated CDP571, a humanized antibody to tumor necrosis factor, for the treatment of active Crohn's disease. METHODS: One hundred sixty-nine patients with moderate-to-severe Crohn's disease were enrolled in a 24-week placebo-controlled trial. Patients were initially randomized to a single dose of 10 or 20 mg/kg CDP571 or placebo to assess dose response. Patients were then retreated with 10 mg/kg CDP571 or placebo every 8 or 12 weeks to assess subsequent dosing intervals. The primary endpoint was clinical response at week 2, defined as a decrease in the Crohn's Disease Activity Index score > or = 70 points. RESULTS: At week 2, clinical response occurred in 45% of CDP571-treated patients compared with 27% of patients in the placebo group (P = 0.023). Patients appeared to benefit from retreatment with CDP571 over 24 weeks, but not all of the results for secondary endpoints were statistically significant. The frequency of severe or serious adverse events was similar among all groups. CONCLUSIONS: CDP571 at an initial dose of 10 or 20 mg/kg is safe and effective for treatment of patients with moderate-to-severe Crohn's disease. Preliminary evidence suggests that retreatment with 10 mg/kg CDP571 at dose intervals of 8 or 12 weeks may also be beneficial, but additional studies are needed.

Adolescent↗
PubMed2000

Immunization and the American way: 4 childhood vaccines.

Childhood immunization constitutes one of the great success stories of American public health in the 20th century. This essay provides a historical examination of this topic through 4 particularly important examples: diphtheria, pertussis, polio, and measles. Each case study illustrates how new vaccines have posed unique challenges related to basic science, clinical trial methodology, medical ethics, and public acceptance. A brief comparison of each story to the experience of Great Britain, however, suggests an underlying unity connecting all 4 examples. Whereas the British led the way in introducing formal clinical trial methodology in the field of immunization development, the Americans excelled in the rapid translation of laboratory knowledge into strategies suitable for mass application. Although this distinction appears to have diminished in recent years, it offers insight into the sources of creativity underlying American vaccine development and the corresponding difficulties sometimes created for utilizing vaccines fruits rationally.

Child↗
PubMed1998

Myosins: matching functions with motors.

It is an exciting time to be studying myosins and their roles in the function of cells and organisms. Past efforts aimed at finding new members of this family have now given way to a focus on identifying individual functions for each motor protein. These actin-based motors are now known to be intimately involved in the following processes: neurosensory function; vesicle trafficking; determinant partitioning; and cortical function. The following article reviews the inroads made into the functions of myosins in these processes over the past several years.

Animals↗
PubMed1997

A family of unconventional myosins from the nematode Caenorhabditis elegans.

The unconventional myosins are a superfamily of actin-based motor proteins that are expressed in a wide range of cell types and organisms. Thirteen classes of unconventional myosin have been defined, and current efforts are focused on elucidating their individual functions in vivo. Here, we report the identification of a family of unconventional myosin genes in Caenorhabditis elegans. The hum-1, hum-2, hum-3 and hum-6 (heavy chain of an unconventional myosin) genes encode members of myosin classes I, V, VI and VII, respectively. The hum-4 gene encodes a high molecular mass myosin (ca 307 kDa) that is one of the most highly divergent myosins, and is the founding and only known member of class XII. The physical position of each hum gene has been determined. The hum-1, hum-2 and hum-3 genes have been mapped by extrapolation near previously uncharacterized mutations, several of which are lethal, identifying potentially essential unconventional myosin genes in C. elegans.

Amino Acid Sequence↗
PubMed1996

Treatment of left-sided ulcerative colitis with butyrate enemas: a controlled trial.

BACKGROUND: The colonic mucosa is highly dependent upon the presence of luminal nutrients. This dependence is most marked in the distal colon. The major luminal nutrients are short chain fatty acids that are produced as a by-product of colonic fermentation of carbohydrates. Butyrate appears to be the short chain fatty acid most avidly metabolized by the colonic mucosa. It has been suggested that ulcerative colitis is, at least in part, related to an energy deficiency state of the colonic mucosa which may be secondary to impaired short chain fatty acid production, uptake or utilization. The objective of this study was to determine if butyrate given as enema therapy is effective in the treatment of active distal ulcerative colitis. METHODS: Thirty-eight patients with distal ulcerative colitis were randomly assigned to receive nightly butyrate (n = 19) or saline/placebo (n = 19) enemas. Butyrate enemas consisted of 60 mL of 80 mM sodium butyrate titrated to a pH of 7.0. Patients were assessed clinically and endoscopically at baseline and at 3 and 6 weeks follow-up. Pre- and post-treatment mucosal biopsies were assessed histologically. Response to therapy was determined by changes in a 12-point clinical disease activity index score based on patient symptoms, endoscopic mucosal appearance and physicians' global assessment. RESULTS: Clinical improvement was noted in seven of 19 (37%) butyrate-treated patients and nine of 19 (47%) placebo-treated patients (P = 0.51). Clinical remission was achieved in three patients in each group (16%). No toxicity was observed in either treatment arm. CONCLUSIONS: The results suggests that once nightly 60 mL butyrate enemas (80 mmol/L) are not efficacious in the treatment of distal ulcerative colitis.

Adult↗
PubMed1994

Critical assessment of body-composition measurements in malnourished subjects with Crohn's disease: the role of bioelectric impedance analysis.

Bioelectric impedance analysis (BIA) has been widely used for assessment of body composition in healthy subjects but has not been validated in malnourished patients. This study compared calculation of fat-free mass (FFM) by five methods to determine whether the currently used equations for total body water (TBW) as assessed by BIA were applicable to 19 malnourished patients with Crohn's disease. When compared with TBW assessed by H2(18)O dilution, BIA was higher by 5.9 +/- 1.1% (P < 0.005). A stepwise-multiple-regression equation was derived to validate BIA: TBW (kg) = 0.25 (ht2/resistance) + 0.29 (wt) + 3.63 (r = 0.97, SEE = 0.28). Comparison of the hydration of FFM (TBW by 18O dilution/FFM) between methods showed that total body potassium (TBK) gave a significantly higher value when compared with the reference method of body protein, mineral, and 18O analysis. Dual-energy x-ray absorptiometry (DXA) provided a value for TBW/FFM in close agreement with the reference method. We conclude that BIA overestimates TBW, and TBK underestimates FFM in malnourished patients. DXA provides an accurate measurement of body fat in malnutrition.

Absorptiometry, Photon↗
PubMed1994

Comparison of amino acid v peptide based enteral diets in active Crohn's disease: clinical and nutritional outcome.

Elemental diets are considered an effective primary treatment for active Crohn's disease. This study examined the hypothesis that improvement occurs because of the presence of amino acids or the low fat content, or both. A randomised, controlled trial was undertaken in 40 patients with active Crohn's disease to evaluate clinical and nutritional outcomes after an amino acid based diet containing 3% fat was given by a feeding tube compared with a peptide based diet containing 33% fat. After three weeks' treatment, clinical remission occurred in 84% of patients who were given the amino acid diet and 75% of patients who received the peptide diet (p = 0.38). Plasma linoleic acid concentration was reduced after the amino acid but not the peptide diet. An increase in total body nitrogen was associated with the magnitude of nutritional depletion before treatment and at six months' follow up, only patients who showed gains in total body nitrogen after enteral nutrition had a sustained clinical remission. This study shows that peptide based high fat diets are as effective as amino acid low fat diets for achieving clinical remission in active Crohn's disease. Improved total body protein stores but not essential fatty acid depletion may be an important indicator of a sustained remission.

Adult↗
PubMed1994

Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas.

BACKGROUND: It is well established that the colonic mucosa is highly dependent upon the luminal presentation of nutrients. This dependence is most marked in the distal colon. The major luminal nutrients are short chain fatty acids (SCFA) that are produced as a by-product of colonic fermentation of carbohydrates. Butyrate appears to be the SCFA that is most avidly metabolized by the colonic mucosa. It has been suggested that ulcerative colitis (UC) is, at least in part, related to an energy deficiency state of the colonic mucosa which may be secondary to impaired SCFA production, uptake, or utilization. OBJECTIVE: To determine if butyrate enemas are safe and effective in refractory distal UC. METHODS: Ten patients with distal UC, refractory to all other available forms of rectal therapy and to oral sulfasalazine or mesalamine (5-ASA), were treated with nightly butyrate enemas in an open-label study. Enemas consisted of 60 ml of 80 mM sodium butyrate titrated to a pH of 7.0. Patients were assessed clinically and endoscopically at baseline and at 3- to 6-wk intervals, and a disease activity score from 0 to 12 was determined. Response to therapy was determined by changes in the activity score. RESULTS: Six of 10 patients responded to therapy. Four of these six had complete responses. The mean disease activity score of all 10 patients fell from 8.0 +/- 2.4 (mean +/- SD) to 4.3 +/- 4.1 at the end of follow-up. Response to therapy could not be predicted based on any of the baseline characteristics analyzed. CONCLUSIONS: In this open-label study, patients with distal UC who were refractory to all previous therapy had a 40% complete response rate and an overall 60% response rate. Controlled studies of this promising therapy are indicated.

Adult↗
PubMed1992

Sensitivity to change for low-ANC eastern US lakes and streams and brook trout populations under alternative sulfate deposition scenarios.

A weight-of-evidence approach was used by the US National Acid Precipitation Assessment Program (NAPAP) to assess the sensitivity of chemistry and biology of lakes and streams to hypothesized changes in sulfate deposition over the next 50 years. The analyses focused on projected effects in response to differences in the magnitude and the timing of changes in sulfate deposition in the north-eastern United States, the Mid-Appalachian Highlands, and the Southern Blue Ridge Province. A number of tools was used to provide the weight of evidence that is required to have confidence in an assessment that has many uncertainties because of the complexity of the systems for which the projections of future conditions were made and because of limited historical data. The MAGIC model provided the projections of chemical changes in response to alternative deposition scenarios. Projected chemical conditions were input into biological models that evaluate effects on fish populations. The sensitivity of water chemistry and brook trout resources to the hypothesized changes in deposition was found to be greatest in the Adirondacks and Mid-Atlantic Highlands. Under the hypothesized sulfur deposition reduction scenarios, chemical conditions suitable for fish were projected to improve 20-30 years sooner than with the scenario that assumed no new legislated controls. Other lines of evidence, e.g. other models, field observations, and paleolimnological findings, were used to evaluate uncertainty in the projections. Model parameter/calibration uncertainty for the chemical models and population sampling uncertainty were explicitly quantified. Model structural uncertainties were bracketed using model comparisons, recent measured changes, and paleolimnological reconstructions of historical changes in lake chemistry.

Journal Article↗