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Tura A, Zhu Y, Vardanyan S, Prasuhn M, Kakkassery V, Lüke J, Merz H, Paulsen F, Rades D, Cremers F, Bartz-Schmidt KU, Grisanti S. Radiation-Induced DNA Damage in Uveal Melanoma Is Influenced by Dose Delivery and Chromosome 3 Status. Invest Ophthalmol Vis Sci 2024; 65:7. [PMID: 38833258 PMCID: PMC11156202 DOI: 10.1167/iovs.65.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 03/15/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose The purpose of this study was to analyze the extent of DNA breaks in primary uveal melanoma (UM) with regard to radiotherapy dose delivery (single-dose versus fractionated) and monosomy 3 status. Methods A total of 54 patients with UM were included. Stereotactic radiotherapy (SRT) was performed in 23 patients, with 8 undergoing single-dose SRT (sdSRT) treatment and 15 receiving fractionated SRT (fSRT). DNA breaks in the enucleated or endoresected tumors were visualized by a TUNEL assay and quantified by measuring the TUNEL-positive area. Protein expression was analyzed by immunohistochemistry. Co-detection of chromosome 3 with proteins was performed by immuno-fluorescent in situ hybridization. Results The amount of DNA breaks in the total irradiated group was increased by 2.7-fold (P < 0.001) compared to non-irradiated tissue. Tumors treated with fSRT were affected more severely, showing 2.1-fold more DNA damage (P = 0.007) compared to the cases after single (high) dose irradiation (sdSRT). Monosomy 3 tumors showed less DNA breaks compared to disomy 3 samples (P = 0.004). The presence of metastases after radiotherapy correlated with monosomy 3 and less DNA breaks compared to patients with non-metastatic cancer in the combined group with fSRT and sdSRT (P < 0.05). Conclusions Fractionated irradiation led to more DNA damage than single-dose treatment in primary UM. As tumors with monosomy 3 showed less DNA breaks than those with disomy 3, this may indicate that they are less radiosensitive, which may influence the efficacy of irradiation.
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Affiliation(s)
- Aysegül Tura
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | - Yingda Zhu
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
- Department of Ophthalmology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Siranush Vardanyan
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | - Michelle Prasuhn
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | - Vinodh Kakkassery
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | - Julia Lüke
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | - Hartmut Merz
- Reference Center for Lymph Node Pathology and Hematopathology, Lübeck, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | - Florian Cremers
- Department of Radiation Oncology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
| | | | - Salvatore Grisanti
- Department of Ophthalmology, University Clinic Schleswig-Holstein (UKSH), University of Lübeck, Lübeck, Germany
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Cao X, Zeng J, Ou Y, Chen J, Lyu J, Zhou Q. A prognostic nomogram for the cancer-specific survival rate of choroidal melanoma using the Surveillance, Epidemiology, and End Results database. Front Med (Lausanne) 2024; 11:1392336. [PMID: 38818391 PMCID: PMC11137212 DOI: 10.3389/fmed.2024.1392336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
Objective This study was conducted to develop a comprehensive nomogram for individuals with choroidal melanoma (CM) to determine their cancer-specific survival (CSS). Methods Data of individuals with CM, diagnosed between 2004 and 2015, were accessed at the Surveillance, Epidemiology, and End Results (SEER) database. The selected individuals were randomly categorized into a training and validation cohort. Multivariate Cox regression analysis was applied to screen the relevant variables. Followed by the development of a nomogram based on independent variables. Ultimately, the net reclassification index (NRI), concordance index (C-index), calibration charts, integrated discrimination improvement (IDI), receiver operating characteristic curves (ROC), area under the curve (AUC), and decision-curve analysis (DCA), were utilized to evaluate the discrimination, accuracy, and effectiveness of the model. Results This study enrolled 3,782 patients. Seven independent factors linked to prognosis were screened via multivariate Cox regression analysis, encompassing age at diagnosis; race; AJCC (American Joint Committee on Cancer) stage; histologic type; and therapy method of radiotherapy, surgery, and chemotherapy. The respective C-indexes of the training and validation cohorts were 0.709 and 0.726, indicative of the excellent accuracy of the nomogram. Furthermore, the AUCs of the training and validation cohorts across 3, 5, and 8 years were 0.767, 0.744, and 0.722 as well as 0.772, 0.770, and 0.753, respectively. Evident of the superiority of the established nomogram over the AJCC staging, both the NRI and IDI values exhibited improvement. The favorable clinical impact and good performance of the nomogram were evident via decision curve analyses (DCAs) and calibration plots, respectively. Conclusion This research dealt with establishing and validating a nomogram as a prognostic tool for assessing the prognosis of adult patients with CM utilizing the SEER database. A comprehensive assessment of the nomogram via diverse variables demonstrated its accuracy in predicting the CSS probabilities of CM patients across 3, 5, and 8 years in clinical settings. Notably, its performance surpassed that of the AJCC staging system.
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Affiliation(s)
- Xianfen Cao
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, China
| | - Jing Zeng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Ophthalmic Center, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yulun Ou
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, China
| | - Jian Chen
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qing Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Zhao M, Yu Y, Song Z. Identification and validation of a costimulatory molecule-related signature to predict the prognosis for uveal melanoma patients. Sci Rep 2024; 14:9146. [PMID: 38644411 PMCID: PMC11033288 DOI: 10.1038/s41598-024-59827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
Uveal melanoma (UVM) is the most common primary tumor in adult human eyes. Costimulatory molecules (CMs) are important in maintaining T cell biological functions and regulating immune responses. To investigate the role of CMs in UVM and exploit prognostic signature by bioinformatics analysis. This study aimed to identify and validate a CMs associated signature and investigate its role in the progression and prognosis of UVM. The expression profile data of training cohort and validation cohort were downloaded from The Cancer Genome Atlas (TCGA) dataset and the Gene Expression Omnibus (GEO) dataset. 60 CM genes were identified, and 34 genes were associated with prognosis by univariate Cox regression. A prognostic signature was established with six CM genes. Further, high- and low-risk groups were divided by the median, and Kaplan-Meier (K-M) curves indicated that high-risk patients presented a poorer prognosis. We analyzed the correlation of gender, age, stage, and risk score on prognosis by univariate and multivariate regression analysis. We found that risk score was the only risk factor for prognosis. Through the integration of the tumor immune microenvironment (TIME), it was found that the high-risk group presented more immune cell infiltration and expression of immune checkpoints and obtained higher immune scores. Enrichment analysis of the biological functions of the two groups revealed that the differential parts were mainly related to cell-cell adhesion, regulation of T-cell activation, and cytokine-cytokine receptor interaction. No differences in tumor mutation burden (TMB) were found between the two groups. GNA11 and BAP1 have higher mutation frequencies in high-risk patients. Finally, based on the Genomics of Drug Sensitivity in Cancer 2 (GDSC2) dataset, drug sensitivity analysis found that high-risk patients may be potential beneficiaries of the treatment of crizotinib or temozolomide. Taken together, our CM-related prognostic signature is a reliable biomarker that may provide ideas for future treatments for the disease.
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Affiliation(s)
- Minyao Zhao
- Department of Ophthalmology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yue Yu
- Department of Ophthalmology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhengyu Song
- Department of Ophthalmology, Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Pawlik VE, Sonntag SR, Grisanti S, Tura A, Kakkassery V, Ranjbar M. Impact of Nintedanib and Anti-Angiogenic Agents on Uveal Melanoma Cell Behavior. Invest Ophthalmol Vis Sci 2024; 65:30. [PMID: 38381412 PMCID: PMC10893901 DOI: 10.1167/iovs.65.2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Purpose The purpose of this study was to investigate the direct impact of the combined angiokinase inhibitor nintedanib as well as the anti-angiogenic agents ranibizumab, bevacizumab, and aflibercept on the primary uveal melanoma (UM) cell line Mel270 and liver metastasis UM cell line OMM2.5. Methods The metabolic activity, viability, and oxidative stress levels were analyzed by the Thiazolyl Blue Tetrazolium Bromide (MTT), LIVE/DEAD, and reactive oxygen species (ROS) assays. Expression of intracellular VEGF-A165 and VEGF receptor-2 was detected by immunofluorescent staining. The secretion of VEGF-A165 into the cell culture supernatants was evaluated by VEGF-A165 ELISA. Results Nintedanib, at a concentration of 1 µg/mL, resulted in a median reduction of metabolic activity (for Mel270 of approximately 38% and for OMM2.5 of 46% compared to the untreated control) without exerting toxicity in either cell line, whereas the other 3 substances did not result in any changes (which also means that none of the 4 substances led to an increased cell death). Moreover, nintedanib (1 µg/mL) induced oxidative stress in the Mel270 by approximately 1.2 to 1.5-fold compared to the untreated control, but not the OMM2.5 cells. Conclusions Nintedanib could suppress the growth of UM cells in a concentration-dependent manner. The metastatic UM cell line OMM2.5 was not sensitive to the pro-oxidant activity of nintedanib. This study was the first to investigate nintedanib in the context of UM. We propose further investigation of this substance to elucidate its effects on this tumor entity with the hope of identifying advantageous therapeutic options for future adjuvant tumor therapies.
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Affiliation(s)
- Vera E. Pawlik
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
| | | | | | - Aysegül Tura
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
| | | | - Mahdy Ranjbar
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
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Zhang H, Zhang X, Li H, Wang B, Chen P, Meng J. The roles of macrophage migration inhibitory factor in retinal diseases. Neural Regen Res 2024; 19:309-315. [PMID: 37488883 PMCID: PMC10503606 DOI: 10.4103/1673-5374.379020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/07/2023] [Accepted: 04/28/2023] [Indexed: 07/26/2023] Open
Abstract
Macrophage migration inhibitory factor (MIF), a multifunctional cytokine, is secreted by various cells and participates in inflammatory reactions, including innate and adaptive immunity. There are some evidences that MIF is involved in many vitreoretinal diseases. For example, MIF can exacerbate many types of uveitis; measurements of MIF levels can be used to monitor the effectiveness of uveitis treatment. MIF also alleviates trauma-induced and glaucoma-induced optic nerve damage. Furthermore, MIF is critical for retinal/choroidal neovascularization, especially complex neovascularization. MIF exacerbates retinal degeneration; thus, anti-MIF therapy may help to mitigate retinal degeneration. MIF protects uveal melanoma from attacks by natural killer cells. The mechanism underlying the effects of MIF in these diseases has been demonstrated: it binds to cluster of differentiation 74, inhibits the c-Jun N-terminal kinase pathway, and triggers mitogen-activated protein kinases, extracellular signal-regulated kinase-1/2, and the phosphoinositide-3-kinase/Akt pathway. MIF also upregulates Toll-like receptor 4 and activates the nuclear factor kappa-B signaling pathway. This review focuses on the structure and function of MIF and its receptors, including the effects of MIF on uveal inflammation, retinal degeneration, optic neuropathy, retinal/choroidal neovascularization, and uveal melanoma.
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Affiliation(s)
- Hongbing Zhang
- Shaanxi Institute of Ophthalmology, Xi’an, Shaanxi Province, China
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China
| | - Xianjiao Zhang
- Department of Pathology, First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China
| | - Hongsong Li
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China
| | - Bing Wang
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China
| | - Pei Chen
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China
| | - Jiamin Meng
- Department of Ophthalmology, First Affiliated Hospital of Northwest University, Xi’an, Shaanxi Province, China
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Wespiser M, Neidhardt E, Negrier S. Uveal melanoma: In the era of new treatments. Cancer Treat Rev 2023; 119:102599. [PMID: 37473516 DOI: 10.1016/j.ctrv.2023.102599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
Uveal melanoma (UM), also known as choroidal melanoma, is the leading adult intraocular tumor worldwide, affecting mainly Caucasian populations. The last decade has seen an improvement in the outcome of these tumors at the localized stage, in favor of conservative treatment of the eye, notably with new radioactive treatment techniques. Despite optimal management, half of the patients will become metastatic, with liver involvement in 90% of cases. The prognosis is pejorative and considers clinical, tumor anatomy, histological and molecular parameters. This review provides a broad overview of the different therapeutic options for the management of localized or metastatic UM disease, with recently updated data. Despite the known limited efficacy of chemotherapy and immune checkpoint inhibitors (ICI), we discuss the first results of combined immunotherapies, the arrival of a new first-in-class immunomodulatory treatment Tebentafusp, in HLA-A*02:01 patients, avenues of research into targeted anti-tyrosine kinase therapies, and the growing use of ctDNA to guide treatment prescription.
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Affiliation(s)
- M Wespiser
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.
| | - E Neidhardt
- Centre Léon Bérard, University of Lyon, Lyon, France.
| | - S Negrier
- Centre Léon Bérard, University of Lyon, Lyon, France.
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Jakubechova J, Smolkova B, Furdova A, Demkova L, Altanerova U, Nicodemou A, Zeleznikova T, Klimova D, Altaner C. Suicide-Gene-Modified Extracellular Vesicles of Human Primary Uveal Melanoma in Future Therapies. Int J Mol Sci 2023; 24:12957. [PMID: 37629139 PMCID: PMC10454466 DOI: 10.3390/ijms241612957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Extracellular vesicles secreted from uveal melanoma (UM) cells are involved in the establishment of the premetastatic niche and display transforming potential for the formation of metastases, preferentially in the liver. In this study, we cultivated human primary UM cells and uveal melanoma-associated fibroblasts in vitro to be transduced by infection with a retrovirus containing the suicide gene-fused yeast cytosine deaminase::uracil phospho-ribosyl transferase (yCD::UPRT). A homogenous population of yCD::UPRT-UM cells with the integrated provirus expressed the gene, and we found it to continuously secrete small extracellular vesicles (sEVs) possessing mRNA of the suicide gene. The yCD::UPRT-UM-sEVs were internalized by tumor cells to the intracellular conversion of the prodrug 5-fluorocytosine (5-FC) to the cytotoxic drug 5-fluorouracil (5-FU). The host range of the yCD::UPRT-UM-sEVs was not limited to UMs only. The yCD::UPRT-UM-sEVs inhibited the growth of the human cutaneous melanoma cell line A375 and uveal melanoma cell line MP38, as well as other primary UMs, to various extents in vitro. The yCD::UPRT-UM-sEVs hold the therapeutic and prophylactic potential to become a therapeutic drug for UM. However, the use of yCD::UPRT-UM-sEVs must first be tested in animal preclinical studies.
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Affiliation(s)
- Jana Jakubechova
- Cancer Research Institute, Biomedical Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
- Stem Cell Preparation Department, St. Elisabeth Cancer Institute, 812 50 Bratislava, Slovakia; (U.A.)
| | - Bozena Smolkova
- Cancer Research Institute, Biomedical Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Alena Furdova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, 814 99 Bratislava, Slovakia
| | - Lucia Demkova
- Cancer Research Institute, Biomedical Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
| | - Ursula Altanerova
- Stem Cell Preparation Department, St. Elisabeth Cancer Institute, 812 50 Bratislava, Slovakia; (U.A.)
| | - Andreas Nicodemou
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, 814 99 Bratislava, Slovakia; (A.N.)
| | - Tatiana Zeleznikova
- Stem Cell Preparation Department, St. Elisabeth Cancer Institute, 812 50 Bratislava, Slovakia; (U.A.)
| | - Daniela Klimova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, 814 99 Bratislava, Slovakia; (A.N.)
| | - Cestmir Altaner
- Cancer Research Institute, Biomedical Center, Slovak Academy of Sciences, 845 05 Bratislava, Slovakia
- Stem Cell Preparation Department, St. Elisabeth Cancer Institute, 812 50 Bratislava, Slovakia; (U.A.)
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Gozzo L, Nardo A, Brancati S, Judica A, Duminuco A, Maugeri C, Parisi M, Longo L, Vitale DC, Ruscica R, Romano GL, Mauro E, Fiumara PF, Palumbo GAM, Di Raimondo F, Vetro C, Drago F. Severe Gastrointestinal Toxicity Following the Use of Gilteritinib: A Case Series and Analysis of Postmarketing Surveillance Data. Healthcare (Basel) 2023; 11:healthcare11101479. [PMID: 37239765 DOI: 10.3390/healthcare11101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Gilteritinib has been approved as monotherapy in adults with acute myeloid leukemia (AML) FLT3 mutated with relapsed or refractory disease, in light of its advantages in terms of survival and the favorable safety profile. Hepatobiliary disorders and musculoskeletal and connective tissue disorders represent the most frequent adverse reactions associated with gilteritinib, whereas the most frequent serious adverse reaction is acute kidney injury. In the summary of product characteristics, gastrointestinal (GI) events are indicated as very common, in particular diarrhea, nausea and stypsis. Furthermore, serious GI disorders have been observed with gilteritinib in clinical trials, including GI hemorrhage, GI perforation and GI obstruction. However, the association with the FLT3 inhibitor has not been confirmed. Nevertheless, serious GI AEs have been recognized as an important potential risk to be monitored in postmarketing surveillance. We present three cases of serious self-limiting GI events observed in patients on gilteritinib treatment for AML, and an analysis of relevant available postmarketing surveillance data.
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Affiliation(s)
- Lucia Gozzo
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Antonella Nardo
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Serena Brancati
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Antongiulio Judica
- Gastroenterology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Andrea Duminuco
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Cinzia Maugeri
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Marina Parisi
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Laura Longo
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Daniela Cristina Vitale
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Rosy Ruscica
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Elisa Mauro
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Paolo Fabio Fiumara
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Giuseppe Alberto Maria Palumbo
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Francesco Di Raimondo
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
- Department of Chirurgia Generale e Specialità Medico-Chirurgiche, University of Catania, 95123 Catania, Italy
| | - Calogero Vetro
- Haematology Unit, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
| | - Filippo Drago
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", 95123 Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Centre for Research and Consultancy in HTA and Drug Regulatory Affairs (CERD), University of Catania, 95123 Catania, Italy
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Elfalah M, AlRyalat SA, Abu-Yaghi NE, Mohammad M, AlNawiaseh I, Rayyan D, Albliwi M, Elfalah M, AlSarairah F, Yousef YA. The Impact of Color Vision Deficiency on the Capability of Ophthalmologists to Diagnose Benign and Malignant Choroidal Tumors. J Clin Med 2023; 12:jcm12072744. [PMID: 37048826 PMCID: PMC10094880 DOI: 10.3390/jcm12072744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Color vision deficiency (CVD) is an under-reported problem among medical personnel, and its impact is still not well characterized. We aim to assess the impact of CVD among ophthalmologists on the accuracy of diagnosing different benign and malignant choroidal lesions. METHODS This is a cross-sectional study conducted on ophthalmologists. We used a web-based survey to collect responses through professional ophthalmology society social media. The survey included a set of five images for normal fundus, choroidal nevus, circumscribed choroidal hemangioma, choroidal metastasis, and choroidal melanoma, wherein each image simulated the three main types of CVD: protanopia, deuteranopia, and tritanopia, in addition to a non-simulated image. RESULTS Forty-one participants were included, with a mean age of 40 (±9.2) years. They were 28 (68%) men and 13 (32%) women. Participants showed significantly low accuracy for definite diagnosis for circumscribed choroidal hemangioma, nevus, melanoma, and metastasis when the images simulated protanopia and deuteranopia, but not tritanopia. Nevertheless, participants maintained the capability to recognize the nature of the lesions for both simulated and non-simulated images if they were benign or malignant, thereby ensuring immediate referral for specialized care. The exception was with simulated choroidal nevi images, wherein participants incorrectly assigned simulated protanopia and deuteranopia nevi images to malignant lesions. CONCLUSION Protanopia and deuteranopia affected the accuracy of diagnosing several choroidal lesions; however, ophthalmologists with those two simulated CVDs were still able to discriminate between benign and malignant tumors.
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Affiliation(s)
- Mutasem Elfalah
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Saif Aldeen AlRyalat
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Nakhleh E Abu-Yaghi
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mona Mohammad
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan
| | - Ibrahim AlNawiaseh
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan
| | - Deema Rayyan
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Moath Albliwi
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan
| | - Mohammad Elfalah
- Division of Ophthalmology, Department of Special Surgery, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Fawaz AlSarairah
- Ophthalmology Department, Faculty of Medicine, Mutah University, Mutah 61710, Jordan
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman 11941, Jordan
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Bucolo C, Maugeri G, Giunta S, D’Agata V, Drago F, Romano GL. Corneal wound healing and nerve regeneration by novel ophthalmic formulations based on cross-linked sodium hyaluronate, taurine, vitamin B6, and vitamin B12. Front Pharmacol 2023; 14:1109291. [PMID: 36817120 PMCID: PMC9932323 DOI: 10.3389/fphar.2023.1109291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction: To evaluate the pharmacological profile of ocular formulations based on cross-linked sodium hyaluronate (CL-SH), taurine (Tau), vitamin B6 (Vit B6) and vitamin B12 (Vit B12) using in vitro and in vivo paradigms. Methods: Rabbit corneal epithelial cells were used to assess wound healing and reactive oxygen species (ROS) formation by scratch assay and oxidative stress (0.3 mM H2O2; 30 min), respectively with or without ocular formulations exposure. In vivo studies were carried out on albino rabbits to evaluate corneal nerve regeneration and corneal wound healing with or without treatment with six different formulations. Animals were anesthetized, the corneal epithelium was removed, and formulations were topically administered (30 μL/eye; 3 times/day for 6 days). Slit-lamp observation was carried out at different time points. After 6 days the animals were killed, and corneas were collected to evaluate corneal re-innervation by immunohistochemistry of selective neuronal marker β-III tubulin. Results: Formulations containing the concentrations 0.16% or 0.32% of cross-linked sodium hyaluronate, taurine, vitamin B6 and vitamin B12 accelerated corneal wound healing. Cells exposed to H2O2 led to significant (p < 0.05) increase of reactive oxygen species concentration that was significantly (p < 0.05) counteract by formulations containing cross-linked sodium hyaluronate (0.32%) and taurine with or without vitamins. The extent of re-innervation, in terms of β-III tubulin staining, was 5-fold greater (p < 0.01) in the eye of rabbits treated with formulation containing 0.32% cross-linked sodium hyaluronate, taurine, vitamins (RenerviX®) compared with the control group (no treatment). Furthermore, re-innervation elicited by RenerviX® was significantly greater (p < 0.01) compared with the group treated with the formulation containing 0.32% cross-linked sodium hyaluronate and taurine without vitamins, and with the group treated with the formulation containing 0.5% linear sodium hyaluronate (SH), taurine, and vitamin B12, respectively. Discussion: In conclusion, among the formulations tested, the new ophthalmic gel RenerviX® was able to contrast oxidative stress, to accelerate corneal re-epithelization and to promote nerve regeneration.
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Affiliation(s)
- Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology-CERFO, University of Catania, Catania, Italy,*Correspondence: Claudio Bucolo,
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Salvatore Giunta
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Velia D’Agata
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology-CERFO, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology-CERFO, University of Catania, Catania, Italy
| | - Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy,Center for Research in Ocular Pharmacology-CERFO, University of Catania, Catania, Italy
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Gozzo L, Romano GL, Brancati S, Longo L, Vitale DC, Drago F. The therapeutic value of treatment for multiple sclerosis: analysis of health technology assessments of three European countries. Front Pharmacol 2023; 14:1169400. [PMID: 37188269 PMCID: PMC10175632 DOI: 10.3389/fphar.2023.1169400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
In accordance with European regulation, medicines containing a new active substance to treat neurodegenerative diseases as well as autoimmune and other immune dysfunctions must be approved by the European Medicines Agency (EMA) through the centralized procedure before they can be marketed. However, after EMA approval, each country is responsible for national market access, following the assessment performed by health technology assessment (HTA) bodies with regard to the therapeutic value. This study aims to provide a comparative analysis of HTA recommendations issued by three EU countries (France, Germany, and Italy) for new drugs for multiple sclerosis (MS) following EMA approval. In the reference period, we identified 11 medicines authorized in Europe for MS, including relapsing forms of MS (RMS; n = 4), relapsing-remitting MS (RRMS; n = 6), secondary progressive MS (SPMS; n = 1), and the primary progressive form (PPMS; n = 1). We found no agreement on the therapeutic value (in particular, the "added value" compared to the standard of care) of the selected drugs. Most evaluations resulted in the lowest score ("additional benefit not proven/no clinical improvement"), underlining the need for new molecules with better efficacy and safety profiles for MS, especially for some forms and clinical settings.
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Affiliation(s)
- Lucia Gozzo
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- *Correspondence: Lucia Gozzo,
| | - Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Serena Brancati
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Laura Longo
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Daniela Cristina Vitale
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Filippo Drago
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Centre for Research and Consultancy in HTA and Drug Regulatory Affairs (CERD), University of Catania, Catania, Italy
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12
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Wang J, Qiao S, Liang S, Qian C, Dong Y, Pei M, Wang H, Wan G. TRPM4 and TRPV2 are two novel prognostic biomarkers and promising targeted therapy in UVM. Front Mol Biosci 2022; 9:985434. [PMID: 36081847 PMCID: PMC9445434 DOI: 10.3389/fmolb.2022.985434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/01/2022] [Indexed: 12/21/2022] Open
Abstract
Uveal melanoma (UVM) is the most common primary intraocular malignancy tumor in adults. Almost 50% of UVM patients develop metastatic disease, and is usually fatal within 1 year. However, the mechanism of etiology remains unclear. The lack of prognostic, diagnostic and therapeutic biomarkers is a main limitation for clinical diagnosis and treatment. The transient receptor potential (TRP) channels play important roles in the occurrence and development of tumors, which may have the potential as a therapeutic target for UVM. This current study aimed to identify the potential effect and function of the TRPs that could provide survival prediction and new insight into therapy for UVM. Based on the transcriptome data and potential key genes of UVM were screened using the Cancer Genome Atlas (TCGA) databases, Gene expression analysis showed the expression of TRPM4, TRPV2 and other TRPs was high levels in UVM. Using survival analysis, we screened out that the high expression of TRPM4 and TRPV2 was negatively correlated with the prognosis of UVM patients. Cox regression analysis and functional enrichment analysis further indicated that TRPM4 and TRPV2 were the most convincing therapeutic targets of UVM, and the majority of genes involved in ferroptosis pathways in UVM showed positively correlated with the expression levels of TRPM4 and TRPV2. In conclusion, TRPM4 and TRPV2 were considered as two novel prognostic biomarkers and a promising targeted therapy in UVM.
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Affiliation(s)
- Jiong Wang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Qiao
- Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Shenzhi Liang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cheng Qian
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Dong
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Minghang Pei
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongmei Wang
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing, China
- *Correspondence: Hongmei Wang, ; Guangming Wan,
| | - Guangming Wan
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Hongmei Wang, ; Guangming Wan,
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Bioequivalence, Drugs with Narrow Therapeutic Index and the Phenomenon of Biocreep: A Critical Analysis of the System for Generic Substitution. Healthcare (Basel) 2022; 10:healthcare10081392. [PMID: 35893214 PMCID: PMC9394341 DOI: 10.3390/healthcare10081392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
The prescription of generic drugs represents one of the main cost-containment strategies of health systems, aimed at reducing pharmaceutical expenditure. In this context, most regulatory authorities encourage or obligate dispensing generic drugs because they are far less expensive than their brand-name alternatives. However, drug substitution can be critical in particular situations, such as the use of drugs with a narrow therapeutic index (NTI). Moreover, generics cannot automatically be considered bioequivalent with each other due to the biocreep phenomenon. In Italy, the regulatory authority has established the Transparency Lists which include the medications that will be automatically substituted for brand-name drugs, except in exceptional cases. This is a useful tool to guide prescribers and guarantee pharmaceutical sustainability, but it does not consider the biocreep phenomenon.
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14
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Salmon B, Schalenbourg A. "De novo" Appearance of a Choroidal Melanoma During 5 Years' Follow-up for CHRPE. Klin Monbl Augenheilkd 2022; 239:590-592. [PMID: 35472812 DOI: 10.1055/a-1785-5349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Basile Salmon
- Ophthalmology, Hôpital ophtalmique Jules-Gonin, University of Lausanne, Lausanne, Switzerland
| | - Ann Schalenbourg
- Ophthalmology, Hôpital ophtalmique Jules-Gonin, University of Lausanne, Lausanne, Switzerland
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15
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Zhang C, Zhu X, Hou S, Pan W, Liao W. Functionalization of Nanomaterials for Skin Cancer Theranostics. Front Bioeng Biotechnol 2022; 10:887548. [PMID: 35557870 PMCID: PMC9086318 DOI: 10.3389/fbioe.2022.887548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Skin cancer has drawn attention for the increasing incident rates and high morbidity worldwide. Timely diagnosis and efficient treatment are of paramount importance for prompt and effective therapy. Thus, the development of novel skin cancer diagnosis and treatment strategies is of great significance for both fundamental research and clinical practice. Recently, the emerging field of nanotechnology has profoundly impact on early diagnosis and better treatment planning of skin cancer. In this review, we will discuss the current encouraging advances in functional nanomaterials for skin cancer theranostics. Challenges in the field and safety concerns of nanomaterials will also be discussed.
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Affiliation(s)
- Chao Zhang
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xinlin Zhu
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shuming Hou
- Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Weihua Pan
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Wanqing Liao, ; Weihua Pan,
| | - Wanqing Liao
- Department of Dermatology, Changzheng Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Wanqing Liao, ; Weihua Pan,
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Albarry MA, Parekh M, Ferrari S, Eltahir HM, Shehata AM, Shaker MA, Elbadawy HM. Incremental Concentrations of Tacrolimus Eye Drops as a Strategy for the Management of Severe Vernal Keratoconjunctivitis. Front Pharmacol 2022; 13:798998. [PMID: 35401178 PMCID: PMC8990096 DOI: 10.3389/fphar.2022.798998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To assess the effect of different concentrations of tacrolimus eye suspension on the epithelium and stromal keratocytes of human corneas and investigate whether it can be safely used for severe cases of vernal keratoconjunctivitis (VKC). Methods: Tacrolimus eye suspension was prepared in a range of concentrations of 0.005%, 0.01%, 0.05%, 0.1%, and 0.2%. Molecular analysis was performed ex vivo on human corneas (n = 18), obtained from the eye bank. Transparency and thickness of each cornea were measured while live/dead staining was performed using a triple labeling assay. An incremental concentration approach was then tested on three severe cases of VKC. Results: All tested tacrolimus concentrations showed no significant changes in corneal thickness or transparency. In corneas treated with 0.1%, rare scattered dead cells were observed, while the folds of corneal surfaces were mostly viable, unlike concentrations higher than 0.1% and lower than 0.05%. Stromal cell densities were highest in the 0.1% tacrolimus treatment condition. Incremental concentrations of tacrolimus suspension were shown to significantly improve VKC cases, where the concentration used for each case depended on the severity of the case. Conclusions: Topical administration of tacrolimus was not toxic to human corneal cells at all tested concentrations, and the 0.1% concentration has shown the best viability of the corneal tissue. Tacrolimus eye suspension was shown to be safe and effective for use in severe VKC and is proposed as a topical ocular immunosuppressant drug enabling clinicians to incrementally increase the drug concentration according to the clinical severity of the disease to achieve the optimal therapeutic response.
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Affiliation(s)
- Maan Abdullah Albarry
- Department of Ophthalmology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Mohit Parekh
- Institute of Ophthalmology, University College London, London, United Kingdom
- International Center for Ocular Physiopathology, Veneto Eye Bank Foundation, Venice, Italy
| | - Stefano Ferrari
- International Center for Ocular Physiopathology, Veneto Eye Bank Foundation, Venice, Italy
| | - Heba Mahmoud Eltahir
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
| | - Ahmed M Shehata
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
- Department of Pharmacology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed A Shaker
- Pharmaceutics and Pharmaceutical Technology Department, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
- Pharmaceutics Department, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Hossein Mostafa Elbadawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Madinah, Saudi Arabia
- *Correspondence: Hossein Mostafa Elbadawy,
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17
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Gozzo L, Romano GL, Brancati S, Cicciù M, Fiorillo L, Longo L, Vitale DC, Drago F. Access to Innovative Neurological Drugs in Europe: Alignment of Health Technology Assessments Among Three European Countries. Front Pharmacol 2022; 12:823199. [PMID: 35185551 PMCID: PMC8854989 DOI: 10.3389/fphar.2021.823199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 01/25/2023] Open
Abstract
Even for products centrally approved, each European country is responsible for national market access after European Medicines Agency (EMA) approval. This step can result in inequalities in terms of access, due to different opinions about the therapeutic value assessed by Health Technology Assessment (HTA) bodies. This study aims to provide a comparative analysis of HTA recommendations issued by EU countries (France, Germany, and Italy) for new neurological drugs following EMA approval. In the reference period, we identified 11 innovative medicines authorized in Europe for five neurological diseases (cerebral adrenoleukodystrophy, spinal muscular atrophy, metachromatic leukodystrophy, migraine, and polyneuropathy in patients with hereditary transthyretin amyloidosis), including eight drugs for genetic rare diseases. We found no agreement on the therapeutic value (in particular the “added value” compared to the standard of care) of the selected drugs. Despite the differences in terms of assessment, the access has been usually guaranteed even if with various types of limitations. The heterogeneity of the HTA assessment of clinical data among countries is probably related to the uncertainties about clinical value at the time of EMA approval and the lack of long-term data and of direct comparison with available alternatives. Given the importance of new medicines especially for rare diseases, it is crucial to understand and act on the causes of inconsistency among the HTA assessments, in order to ensure rapid and uniform access to innovation for patients who can benefit.
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Affiliation(s)
- Lucia Gozzo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- *Correspondence: Lucia Gozzo,
| | - Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Serena Brancati
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences Morphological and Functional Images, University of Messina, AOU “G. Martino”, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences Morphological and Functional Images, University of Messina, AOU “G. Martino”, Messina, Italy
| | - Laura Longo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Daniela Cristina Vitale
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Filippo Drago
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Centre for Research and Consultancy in HTA and Drug Regulatory Affairs (CERD), University of Catania, Catania, Italy
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18
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OUP accepted manuscript. J Pharm Pharmacol 2022; 74:660-680. [DOI: 10.1093/jpp/rgac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
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New Perspectives for Eye-Sparing Treatment Strategies in Primary Uveal Melanoma. Cancers (Basel) 2021; 14:cancers14010134. [PMID: 35008296 PMCID: PMC8750035 DOI: 10.3390/cancers14010134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Uveal melanoma is the most common intraocular cancer. The current eye-sparing treatment options include mostly plaque brachytherapy. However, the effectiveness of these methods is still unsatisfactory. In this article, we review several possible new treatment options. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Another approach may be based on improving the penetration of the anti-cancer agents. It seems that the most promising technologies from this group are based on enhancing drug delivery by applying electric current. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced studies on experimental animals and clinical trials would be needed to introduce some of these techniques to routine clinical practice. Abstract Uveal melanoma is the most common intraocular malignancy and arises from melanocytes in the choroid, ciliary body, or iris. The current eye-sparing treatment options include surgical treatment, plaque brachytherapy, proton beam radiotherapy, stereotactic photon radiotherapy, or photodynamic therapy. However, the efficacy of these methods is still unsatisfactory. This article reviews several possible new treatment options and their potential advantages in treating localized uveal melanoma. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Two examples of such an approach are High-Intensity Focused Ultrasound (HIFU)—a promising technology of thermal destruction of solid tumors located deep under the skin and sonodynamic therapy (SDT) that induces reactive oxygen species. Another approach may be based on improving the penetration of anti-cancer agents into UM cells. The most promising technologies from this group are based on enhancing drug delivery by applying electric current. One such approach is called transcorneal iontophoresis and has already been shown to increase the local concentration of several different therapeutics. Another technique, electrically enhanced chemotherapy, may promote drug delivery from the intercellular space to cells. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced and targeted preclinical studies and clinical trials would be needed to introduce some of these techniques to routine clinical practice.
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Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review. J Clin Med 2021; 10:jcm10214880. [PMID: 34768406 PMCID: PMC8585020 DOI: 10.3390/jcm10214880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022] Open
Abstract
Due to their non-specific diagnostic patterns of ocular infection, differential diagnosis between Mycobacterium (M.) chimaera and tuberculosis can be challenging. In both disorders, ocular manifestation can be the first sign of a systemic infection, and a delayed diagnosis might reduce the response to treatment leading to negative outcomes. Thus, it becomes imperative to distinguish chorioretinal lesions associated with M. chimaera, from lesions due to M. tuberculosis and other infectious disorders. To date, multimodal non-invasive imaging modalities that include ultra-wide field fundus photography, fluorescein and indocyanine green angiography, optical coherence tomography and optical coherence tomography angiography, facilitate in vivo examination of retinal and choroidal tissues, enabling early diagnosis, monitoring treatment response, and relapse detection. This approach is crucial to differentiate between active and inactive ocular disease, and guides clinicians in their decisional-tree during the patients’ follow-up. In this review, we summarized and compared the available literature on multimodal imaging data of M. chimaera infection and tuberculosis, emphasizing similarities and differences in imaging patterns between these two entities and highlighting the relevance of multimodal imaging in the management of the infections.
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