Hereditary inclusion body myopathy (HIBM) is an autosomal recessive adult-onset myopathy due to mutations in the GNE (UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase) gene. Affected patients have no therapeutic options. We have previously demonstrated in preclinical testing the ability to safely correct GNE gene function through liposomal delivery of the wild-type GNE gene. Results were verified in a single patient treated by intravenous infusion of GNE gene lipoplex. A single patient (patient 001) with severe HIBM treated with a compassionate investigational new drug received seven doses of GNE gene lipoplex via intravenous infusion at the following doses: 0.4, 0.4, 1.0, 4.0, 5.0, 6.0, and 7.0 mg of DNA. GNE transgene expression, downstream induction of sialic acid, safety, and muscle function were evaluated. Transient low-grade fever, myalgia, tachycardia, transaminase elevation, hyponatremia, and hypotension were observed after infusion of each dose of GNE gene lipoplex. Quadriceps muscle expression of the delivered GNE, plasmid, and RNA was observed 24 hr after the 5.0-mg dose and at significantly greater levels 72 hr after the 7.0-mg infusion in comparison with expression in quadriceps muscle immediately before infusion. Sialic acid-related proteins were increased and stabilization in the decline of muscle strength was observed. We conclude that clinical safety and activity have been demonstrated with intravenous infusion of GNE gene lipoplex. Further assessment will involve a phase I trial of intravenous administration of GNE gene lipoplex in individuals with less advanced HIBM with more muscle function.

c Studies of cystic fibrosis (CF) patient exacerbations attributed to Pseudomonas aeruginosa infection have indicated a lack of correlation of outcome with in vitro susceptibility results. One explanation is that the media used for testing do not mimic the airway milieu, resulting in incorrect conclusions. Therefore, media have been devised to mimic CF sputum. Aspergillus fumigatus is the leading fungal pathogen in CF, and susceptibility testing is also used to decide therapeutic choices. We assessed whether media designed to mimic CF sputa would give different fungal susceptibility results than those of classical methods, assaying voriconazole, the most utilized anti-Aspergillus drug in this setting, and 30 CF Aspergillus isolates. The frequency of marked resistance (defined as an MIC of >4 g/ml) in our CF unit by classical methods is 7%. Studies performed with classical methods and with digested sputum medium, synthetic sputum medium, and artificial sputum medium revealed prominent differences in Aspergillus susceptibility results, as well as growth rate, with each medium. Clinical correlative studies are required to determine which results are most useful in predicting outcome. Comparison of MICs with non-CF isolates also indicated the CF isolates were generally more resistant. C ystic fibrosis (CF) is a genetic disorder in epithelial anion transport. One result is the development of thick respiratory secretions, which are associated with repeated pulmonary infections and inflammation. The most common bacterium associated with these infections is Pseudomonas aeruginosa. The most common fungal pathogen associated with CF airways is Aspergillus fumigatus. Infection with either has been associated with worsened or a more rapid decline in CF pulmonary function (1-11), with coinfected patients having the worst prognosis (9, 12). In addition, Aspergillus fumigatus causes an allergic bronchopulmonary disease in up to 15% of CF patients (13).An important observation made with respect to Pseudomonas aeruginosa infection in CF patients is the lack of correlation of classical in vitro susceptibility testing of isolates from patients with exacerbations with the treatment outcomes in such patients (14,15). One logical explanation for that dissociation is that classical in vitro susceptibility testing does not mimic the conditions present in CF airways, thus leading to erroneous conclusions with respect to the activity of various antibacterials. For that reason, various researchers have attempted to devise media for use in the laboratory that more closely approximate the milieu of CF airways for purposes of susceptibility testing, as well as studying growth, physiology, mutability, etc., of P. aeruginosa under such conditions. Such media have been shown to give disparate results from those obtained for P. aeruginosa using classical methods (16), such as the methods and medium of the Clinical and Laboratory Standards Institute.With standardization of susceptibility testing for fungi, we wondered whether the routine in vitro...