BACKGROUNDSpinal muscular atrophy is an autosomal recessive neuromuscular disorder that is caused by an insufficient level of survival motor neuron (SMN) protein. Nusinersen is an antisense oligonucleotide drug that modifies pre-messenger RNA splicing of the SMN2 gene and thus promotes increased production of full-length SMN protein. METHODSWe conducted a randomized, double-blind, sham-controlled, phase 3 efficacy and safety trial of nusinersen in infants with spinal muscular atrophy. The primary end points were a motor-milestone response (defined according to results on the Hammersmith Infant Neurological Examination) and event-free survival (time to death or the use of permanent assisted ventilation). Secondary end points included overall survival and subgroup analyses of event-free survival according to disease duration at screening. Only the first primary end point was tested in a prespecified interim analysis. To control the overall type I error rate at 0.05, a hierarchical testing strategy was used for the second primary end point and the secondary end points in the final analysis. RESULTSIn the interim analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (21 of 51 infants [41%] vs. 0 of 27 [0%], P<0.001), and this result prompted early termination of the trial. In the final analysis, a significantly higher percentage of infants in the nusinersen group than in the control group had a motor-milestone response (37 of 73 infants [51%] vs. 0 of 37 [0%]), and the likelihood of event-free survival was higher in the nusinersen group than in the control group (hazard ratio for death or the use of permanent assisted ventilation, 0.53; P = 0.005). The likelihood of overall survival was higher in the nusinersen group than in the control group (hazard ratio for death, 0.37; P = 0.004), and infants with a shorter disease duration at screening were more likely than those with a longer disease duration to benefit from nusinersen. The incidence and severity of adverse events were similar in the two groups. CONCLUSIONSAmong infants with spinal muscular atrophy, those who received nusinersen were more likely to be alive and have improvements in motor function than those in the control group. Early treatment may be necessary to maximize the benefit of the drug. (Funded by Biogen and Ionis Pharmaceuticals; ENDEAR ClinicalTrials.gov number, NCT02193074.)

Neurospecific proteins S-100 and GFAP were measured in the serum of 145 patients with neural tumors and 69 healthy individuals. In patients with glyoblastomas, the concentrations of S-100 and GFAP were significantly higher than in patients with anaplastic astrocytomas, benign meningiomas, and brain metastases and in healthy individuals. Serum S-100 concentrations in patients with anaplastic astrocytomas, benign meningiomas, and brain metastases were similar; significant difference from the control was found only for patients with cerebral metastases. A specific feature of GFAP was high incidence of its detection in patients with glioblastomas (83%) compared to other groups of patients with neural tumors and healthy volunteers who demonstrated practically zero level of this protein. These findings attest to the possibility of using S-100 as an additional biochemical criterion of brain involvement in tumor patients and GFAP as a glioblastoma marker.

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Neuroendocrine tumors (NET) is a heterogeneous group of epithelial neoplasms that develop from cells of the diffuse endocrine system and found in any organ. A distinctive feature of NET is the ability to produce various biologically active peptides and amines. Currently, the most useful markers are the universal marker chromogranin-A (CgA) and specific markers serotonin and 5-hydroxyindolylacetic acid (5-HIAA). The analysis of the clinical significance of the biochemical markers of NETs was carried out by comparative analysis of their levels in serum and urine of 339 NET patients and 66 healthy people. Determination of plasma CgA, serotonin in serum and 5-HIAA in daily urine was performed using standardized ELISA methods using the Chromogranin A ELISA kit (Dako), Serotonin ELISA and 5-HIAA ELISA (IBL) test-systems. The values of CgA, serotonin, 5-HIAA in patients with NET were significantly (p < 0.001) higher than the corresponding control values. Assessment of the diagnostic significance of CgA, taking into account the cut-off level 33 U/l (with a specificity of 98.5%), showed high sensitivity in the general NET group - 80.9%. The serial determination of the marker reflected the effect of treatment. The progression free survival in different treatment regimens for patients with NET has been associated with basal levels of CgA. The medians of serotonin and 5-HIAA levels were maximal in patients with carcinoid syndrome, significantly exceeding the corresponding values in NET patients without clinical manifestations.The data indicate the possibility of using CgA, serotonin and 5-HIAA to improve the accuracy of diagnosis, evaluation of generalization and biological activity of NETs.