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Gould S, Wrzesinski C, Stebbings R, Segal L. Report from an ICT 2022 workshop on toxicology for Covid19 vaccines: Industry, regulatory and CRO perspectives. Vaccine 2023; 41:5919-5924. [PMID: 37633751 DOI: 10.1016/j.vaccine.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
The Covid pandemic took the world by surprise in late 2019 and the need for rapid development of vaccines became paramount. The challenge was how to accelerate standard vaccine development times as much as possible. With knowledge of the genetic code of SARsCOV2, vaccine manufacturers throughout the world have risen to the challenge and several new vaccines were rapidly developed for emergency use. In March 2020, global Regulatory Authorities met to consider how to start early clinical trials and accept rolling submissions. Before use in clinical trials or any mass vaccination campaigns, the safety of the candidate vaccine needs to be evaluated. Non-clinical toxicology studies are required as an important part of vaccine safety evaluation. The extent of the toxicology evaluation prior to the start of clinical trials depended on several factors, including: the type of the candidate vaccine as well as already available supportive information with the candidate vaccine or similar vaccine types. For vaccine candidates with pre-existing data, this would save valuable time whilst a full toxicology evaluation was completed in parallel. For vaccines with more limited data, toxicology data was required before clinical development could start. This workshop examined the nonclinical toxicology studies for new Covid vaccines from the perspectives of: Vaccine manufacturers with different vaccine technologies, managing global regulatory submissions/responses; CROs, managing the urgency of conducting and reporting studies and supporting new players in the vaccine world; and Regulatory Authorities, in supporting the review process, juggling the need for safety and quality with mounting pressure to approve vaccines.
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Gutziet O, Iluz R, Ben Asher H, Segal L, Ben Zvi D, Ginsberg Y, Khatib N, Zmora O, Ross MG, Weiner Z, Beloosesky R. Maternal N-Acetyl-Cysteine Prevents Neonatal Hypoxia-Induced Brain Injury in a Rat Model. Int J Mol Sci 2021; 22:ijms222413629. [PMID: 34948425 PMCID: PMC8709193 DOI: 10.3390/ijms222413629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Perinatal hypoxia is a major cause of infant brain damage, lifelong neurological disability, and infant mortality. N-Acetyl-Cysteine (NAC) is a powerful antioxidant that acts directly as a scavenger of free radicals. We hypothesized that maternal-antenatal and offspring-postnatal NAC can protect offspring brains from hypoxic brain damage.Sixty six newborn rats were randomized into four study groups. Group 1: Control (CON) received no hypoxic intervention. Group 2: Hypoxia (HYP)-received hypoxia protocol. Group 3: Hypoxia-NAC (HYP-NAC). received hypoxia protocol and treated with NAC following each hypoxia episode. Group 4: NAC Hypoxia (NAC-HYP) treated with NAC during pregnancy, pups subject to hypoxia protocol. Each group was evaluated for: neurological function (Righting reflex), serum proinflammatory IL-6 protein levels (ELISA), brain protein levels: NF-κB p65, neuronal nitric oxide synthase (nNOS), TNF-α, and IL-6 (Western blot) and neuronal apoptosis (histology evaluation with TUNEL stain). Hypoxia significantly increased pups brain protein levels compared to controls. NAC administration to dams or offspring demonstrated lower brain NF-κB p65, nNOS, TNF-α and IL-6 protein levels compared to hypoxia alone. Hypoxia significantly increased brain apoptosis as evidenced by higher grade of brain TUNEL reaction. NAC administration to dams or offspring significantly reduce this effect. Hypoxia induced acute sensorimotor dysfunction. NAC treatment to dams significantly attenuated hypoxia-induced acute sensorimotor dysfunction. Prophylactic NAC treatment of dams during pregnancy confers long-term protection to offspring with hypoxia associated brain injury, measured by several pathways of injury and correlated markers with pathology and behavior. This implies we may consider prophylactic NAC treatment for patients at risk for hypoxia during labor.
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Affiliation(s)
- Ola Gutziet
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
- Correspondence: ; Tel.: +972-543088220; Fax: +972-4-7772453
| | - Roee Iluz
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Hila Ben Asher
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Linoy Segal
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Dikla Ben Zvi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Osnat Zmora
- Department of Pediatric Surgery, Shamir Medical Center, Tzrifin 7073001, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Michael G. Ross
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA 92270, USA;
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa 3525433, Israel; (R.I.); (H.B.A.); (L.S.); (D.B.Z.); (Y.G.); (N.K.); (Z.W.); (R.B.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525408, Israel
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Segal L. ES18.03 The Lung Microbiome and Lung Cancer Progression. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gutzeit O, Segal L, Korin B, Iluz R, Khatib N, Dabbah-Assadi F, Ginsberg Y, Fainaru O, Ross MG, Weiner Z, Beloosesky R. Progesterone Attenuates Brain Inflammatory Response and Inflammation-Induced Increase in Immature Myeloid Cells in a Mouse Model. Inflammation 2021; 44:956-964. [PMID: 33405022 PMCID: PMC8139904 DOI: 10.1007/s10753-020-01390-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Abstract
Progesterone has been shown to regulate immunity during pregnancy, and progesterone administration may reduce inflammation-induced preterm labor. We sought to determine the maternal brain immune response to LPS-induced inflammation in pregnant and non-pregnant mice and whether additional progesterone supplementation attenuates this response. Pregnant (P: n = 9) and non-pregnant mice (NP: n = 9) were randomized to pretreatment with vaginal progesterone/carrier (Replens), daily from days 13 to 16. On days 15 and 16, LPS/saline was administered by intraperitoneal injection (Replens + saline n = 3; Replens + LPS n = 3; progesterone + LPS n = 3). Mice were sacrificed on day 16 and maternal serum analyzed for IL-6 levels and brains analyzed for nNOS, NF-kB, IL-6 protein levels and for immature myeloid cells (IMCs) and microglial activity. LPS significantly increased brain nNOS, NF-kB, and IL-6 in both NP and P mice, with significantly greater responses in P mice. In both NP and P groups, progesterone significantly attenuated LPS-induced increase of nNOS and NF-kB, however with no effect on serum IL-6. In the NP brains, LPS significantly increased IMC population and progesterone reduced the IMC phenotype to levels similar to controls. In P mice, neither LPS nor LPS + progesterone altered the brain IMC population. LPS significantly increased the microglial activity in both NP and P groups, which was attenuated by progesterone. Progesterone attenuates brain inflammatory response to LPS in both NP and P mice although it has no effect on systemic inflammation. In NP mice, progesterone attenuated the increase in brain IMC following LPS administration. Our results suggest that endogenous progesterone during pregnancy may protect the brain from LPS-induced inflammation.
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Affiliation(s)
- Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Linoy Segal
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Ben Korin
- Department of Neuroscience, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Immunology, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Roee Iluz
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Fadwa Dabbah-Assadi
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Ofer Fainaru
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Michael G Ross
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rambam Medical Center, 8 Ha'alya St., 3109601, Haifa, Israel.
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Zmora O, Gutzeit O, Segal L, Boulos S, Millo Z, Ginsberg Y, Khatib N, Fainaru O, Ross MG, Weiner Z, Beloosesky R. Maternal N-acetyl-cysteine prevents neonatal brain injury associated with necrotizing enterocolitis in a rat model. Acta Obstet Gynecol Scand 2021; 100:979-987. [PMID: 33247942 DOI: 10.1111/aogs.14054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Preterm infants with necrotizing enterocolitis (NEC) are at increased risk of cerebral injury and neurodevelopmental dysfunction. N-acetyl-cysteine (NAC) is a known anti-inflammatory and antioxidant agent. Currently, there is no prophylactic treatment in clinical use to prevent NEC and its neurodevelopmental sequelae. We sought to determine whether brain inflammation/apoptosis accompanies NEC systemic inflammation, and whether it can be attenuated by maternal NAC treatment during pregnancy and/or in the neonatal period in a rat model. MATERIAL AND METHODS An established NEC newborn model (hypoxia 5% O2 for 10 min and formula feeding thrice daily, beginning on day 1 for 4 days) was used in Sprague-Dawley rat pups (n = 32). An additional group of pups (n = 33) received NAC (300 mg/kg intraperitoneal thrice daily) in addition to NEC conditions (NEC-NAC). Control pups (n = 33) were nursed and remained with the dam in room air. Two additional groups included pups of dams treated once daily with NAC (300 mg/kg intravenous) in the last 3 days of pregnancy. After birth, pups were randomized into NAC-NEC (n = 33) with NEC conditions and NAC-NEC-NAC (n = 36) with additional postnatal NAC treatment. Pups were sacrificed on the fifth day of life. Pup serum interleukin (IL)-6 protein levels, and brain nuclear factor kappa B (NF-κB) p65, neuronal nitric oxide synthase (nNOS), Caspase 3, tumor necrosis factor alpha (TNF-α), IL-6 and IL-1β protein levels were determined by ELISA, western blot and TUNEL staining, and the groups were compared using analysis of variance (ANOVA). RESULTS NEC pups had significantly increased serum IL-6 levels compared with the control group as well as increased neuronal apoptosis and brain protein levels of NF-κB, nNOS, Caspase 3, TNF-α, IL-6 and IL-1β compared with control. In all NAC treatment groups, levels of serum IL-6, neuronal apoptosis and brain NF-κB, nNOS, Caspase 3, TNF-α, IL-6 and IL-1β protein levels were significantly reduced compared with the NEC group. The most pronounced decrease was demonstrated within the NAC-NEC-NAC group. CONCLUSIONS NAC treatment can attenuate newborn inflammatory response syndrome and decrease offspring brain neuroapoptosis and inflammation in a rat model of NEC by inhibition of NF-κB, nNOS and Caspase 3 pathways.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Linoy Segal
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Sari Boulos
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Zvika Millo
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Ofer Fainaru
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Michael G Ross
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, CA, USA
| | - Zeev Weiner
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Ruth, and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
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Kol S, Segal L. GnRH agonist triggering followed by 1500 IU of HCG 48 h after oocyte retrieval for luteal phase support. Reprod Biomed Online 2020; 41:854-858. [PMID: 32873493 DOI: 10.1016/j.rbmo.2020.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
RESEARCH QUESTION Gonadotrophin releasing hormone (GnRH) agonist trigger after GnRH antagonist-based ovarian stimulation protocol for IVF is gaining popularity, because it prevents ovarian hyperstimulation syndrome and allows for near physiological LH and FSH surges. A small dose of HCG (1500 IU) on the day of oocyte retrieval, followed by daily progesterone administration, is currently the preferred way to secure adequate luteal support after GnRH agonist trigger. In the present study, the possibility that a bolus of 1500 IU HCG, given 2 days after oocyte retrieval, may be sufficient to sustain adequate luteal support without additional progesterone treatment was questioned. DESIGN A non-interventional retrospective cohort study between conducted between April 2017 and August 2018. A total of 154 consecutive patients treated with GnRH agonist trigger followed by day-2 HCG (1500 IU) support only (study group) were included. Data were compared with 155 consecutive patients who were treated with HCG (6500 IU) trigger followed by conventional progesterone luteal support (control group). RESULTS Pregnancy, miscarriage and live birth rates were comparable between the study and control groups. In patients who became pregnant, mean oestradiol level 14 days after oocyte retrieval was 4719 pmol/l and 2672 pmol/l in the study and control group, respectively (P < 0.001), reflecting robust luteal activity in the study group. CONCLUSIONS A bolus of 1500 IU HCG, administered 2 days after retrieval, can provide excellent luteal support, without the need for further progesterone supplementation.
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Zmora O, Gutzeit O, Segal L, Boulos S, Millo Z, Ginsberg Y, Khatib N, Dabbah-Assad F, Fainaru O, Weiner Z, Beloosesky R. Prophylactic antenatal N-Acetyl Cysteine administration combined with postnatal administration can decrease mortality and injury markers associated with necrotizing enterocolitis in a rat model. PLoS One 2020; 15:e0233612. [PMID: 32479520 PMCID: PMC7263616 DOI: 10.1371/journal.pone.0233612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease of neonates, especially premature neonates. To date, there is no prophylactic treatment against NEC, except breast milk and slow increase in enteral feeding, and there is no antenatal prophylaxis. AIMS To assess possible protective effects of antenatal N-Acetyl Cysteine (NAC) against the intestinal pathophysiological changes associated with NEC in a rat model of NEC and against its associated mortality. METHODS Newborn Sprague-Dawley rats were divided into 5 groups: control (n = 33); NEC (n = 32)-subjected to hypoxia and formula feeding for 4 days to induce NEC; NEC-NAC (n = 34)-with induced NEC and concomitant postnatal NAC administration; NAC-NEC (n = 33)-born to dams treated with NAC for the last 3 days of pregnancy starting at gestational age of 18 days, and then subjected to induced NEC after birth; NAC-NEC-NAC (n = 36)-subjected to induced NEC with both prenatal and postnatal NAC treatment. At day of life 5, weight and survival of pups in the different groups were examined, and pups were euthanized. Ileal TNF-α, IL-6, IL-1β, IL-10, NFkB p65, iNOS and cleaved caspase 3 protein levels (western blot) and mRNA expression (RT-PCR) were compared between groups. RESULTS Pup mortality was significantly reduced in the NAC-NEC-NAC group compared to NEC (11% vs. 34%, P<0.05). Ileal protein levels and mRNA expression of all injury markers tested except IL-10 were significantly increased in NEC compared to control. These markers were significantly reduced in all NAC treatment groups (NEC-NAC, NAC-NEC, and NAC-NEC-NAC) compared to NEC. The most pronounced decrease was observed in the NAC-NEC NAC group. CONCLUSIONS Antenatal NAC decreases injury markers and mortality associated with NEC in a rat model. Antenatal administration of NAC may present a novel approach for NEC prophylaxis in pregnancies with risk for preterm birth.
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Affiliation(s)
- Osnat Zmora
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin, Israel
| | - Ola Gutzeit
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Linoy Segal
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Sari Boulos
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Zvika Millo
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Fadwa Dabbah-Assad
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Ofer Fainaru
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
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Vanetik S, Beck-Fruchter R, Segal L, Kol S. The Importance of Mid-Follicular Phase Luteinizing Hormone Rise in GnRH Antagonist-Based Ovarian Stimulation for IVF. Gynecol Obstet Invest 2020; 85:184-188. [PMID: 32160630 DOI: 10.1159/000505688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous publications examined the endocrinology of follicular stimulation, focusing on luteinizing hormone (LH) levels changes. In selected, good prognosis IVF patients, a sharp drop in LH serum level was demonstrated between cycle days 2 and 6. OBJECTIVE The purpose of this study was to examine if this finding holds true for unselected patients. METHODS We retrospectively included 165 consecutive patients treated with a GnRH antagonist-based ovarian stimulation protocol during the year 2015. RESULTS AND CONCLUSIONS In 33% of the patients an increase in LH, rather than the expected decrease, was demonstrated after 5 stimulation days. There was no difference in pregnancy outcome. Our results suggest that an increase in LH levels during ovarian stimulation occurs mainly in "high responders", or "low responders". LH rise in mid follicular phase may result in a sharp LH drop once a GnRH antagonist is given, and the possible need for LH supplementation.
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Affiliation(s)
- Sharon Vanetik
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Linoy Segal
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shahar Kol
- IVF Unit, Rambam Health Care Campus, Haifa, Israel, .,IVF Unit, Elisha Hospital, Haifa, Israel,
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Gutzeit O, Segal L, Ginsberg Y, Khatib N, Fainaru O, Ross M, Weiner Z, Beloosesky R. 1019: Progesterone attenuates brain inflammatory response and protects the brain from inflammation-induced immature myeloid cells increase. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Segal L, Etzion S, Elyagon S, Numa M, Livitas A, Muhammad E, Kapiloff M, Parvari R, Etzion Y. DOCK10 is vital for normal cardiac function under neurohormonal activation. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.05.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Segal L, Penman MG, Piriou Y. Evaluation of the systemic toxicity and mutagenicity of OLIGOPIN®, procyanidolic oligomers (OPC) extracted from French Maritime Pine Bark extract. Toxicol Rep 2018; 5:531-541. [PMID: 29725583 PMCID: PMC5930179 DOI: 10.1016/j.toxrep.2018.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/21/2018] [Accepted: 03/31/2018] [Indexed: 11/29/2022] Open
Abstract
The potential systemic toxicity of Oligopin®, a French Maritime Pine Bark extract (FMPBE) rich in procyanidolic oligomers, was evaluated in an acute oral limit test and a 90-day repeated dose oral toxicity study with Sprague Dawley rats. The potential mutagenicity was assessed in a bacterial reverse mutation assay and in vitro mammalian chromosome aberration assay with human lymphocytes. The results indicate that Oligopin® was nongenotoxic in both bacterial and human cell assays, was not acutely toxic via oral administration at up to 2000 mg/kg and was well tolerated following 90 days of oral administration to SD rats, with a no observed adverse effect level of 1000 mg/kg/day. The lack of significant adverse systemic effects in the 90 day study is concordant with findings from several human clinical trials. The acute toxicity and mutagenicity data are consistent with data reported by AFSSA in a summary of FMPBE safety, in which a NOAEL of 100 mg/kg/day was established. In contrast, the NOAEL derived from the 90-day study with Oligopin® was 1000 mg/kg/day, suggesting that it is less systemically toxic than other FMPBE previously evaluated in subchronic studies, and comparable to proanthocyanidins extracted from grape seeds, which are widely used as nutritional supplement ingredients.
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Affiliation(s)
- L Segal
- Penman Consulting BVBA, 1210 Brussels, Belgium
| | - M G Penman
- Penman Consulting BVBA, 1210 Brussels, Belgium
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Hughes JDM, Olynyc T, Chapdelaine H, Segal L, Miedzybrodzki B, Ben-Shoshan M. Effective management of severe cutaneous mastocytosis in young children with omalizumab (Xolair ® ). Clin Exp Dermatol 2018; 43:573-576. [PMID: 29451318 DOI: 10.1111/ced.13408] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2017] [Indexed: 11/29/2022]
Abstract
Omalizumab (Xolair® ) is an anti-IgE monoclonal antibody, which may benefit adults with systemic mastocytosis. We report effective treatment with omalizumab in two toddlers with severe diffuse cutaneous mastocytosis. Our cases offer preliminary evidence to support the safe use of omalizumab in paediatric patients with cutaneous mastocytosis.
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Affiliation(s)
- J D M Hughes
- University of Ottawa - Department of Medicine, Ottawa, Ontario, Canada
| | - T Olynyc
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - H Chapdelaine
- Department of Medicine, Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada
| | - L Segal
- Department of Medicine, Community Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - B Miedzybrodzki
- Department of Pediatrics, Division of Allergy and Clinical Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - M Ben-Shoshan
- Department of Pediatrics, Division of Allergy and Clinical Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Medicine, Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Vanetik S, Segal L, Breizman T, Kol S. Day two post retrieval 1500 IUI hCG bolus, progesterone-free luteal support post GnRH agonist trigger - a proof of concept study. Gynecol Endocrinol 2018; 34:132-135. [PMID: 28933569 DOI: 10.1080/09513590.2017.1379496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Small dose of hCG (1500 IU) on the day of oocyte retrieval, followed by daily progesterone administration, is currently the preferred way to secure adequate luteal support following GnRH agonist trigger. In the current proof-of-concept study, we explored the possibility that a bolus of 1500 IU hCG, given two days after oocyte retrieval, may be sufficient to sustain adequate luteal support without additional progesterone treatment. From February 2015 to August 2016, we obtained 44 pregnancies following GnRHa trigger followed by day 2 hCG (1500 IU) support only (study group). Data from these 44 cycles were compared with the latest 44 pregnancies obtained following hCG (6500 IU) trigger followed by conventional progesterone luteal documented (control group). Mean progesterone levels (14 days postoocyte retrieval) in the study and control groups were 197 nmol/l and 173 nmol/l, respectively (NS). Mean E2 levels (14 days post oocyte retrieval) in the study group was 6937 pmol/l, significantly higher (p < .001) than in the control group (3.276 pmol/l). We conclude that bolus of 1500 IU hCG, administered 2 days after retrieval, can provide excellent support, without the need to further supplement with progesterone.
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Affiliation(s)
- Sharon Vanetik
- a Ruth and Bruce Rappaport Faculty of medicine , Technion - Israel Institute of Technology , Haifa , Israel
| | - Linoy Segal
- a Ruth and Bruce Rappaport Faculty of medicine , Technion - Israel Institute of Technology , Haifa , Israel
| | - Tatiana Breizman
- b Department of Obstetrics and Gynecology , IVF Unit , Haifa , Israel
| | - Shahar Kol
- a Ruth and Bruce Rappaport Faculty of medicine , Technion - Israel Institute of Technology , Haifa , Israel
- b Department of Obstetrics and Gynecology , IVF Unit , Haifa , Israel
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Eshet S, Milner E, Segal L, Monzer A, Kol S. [IN VITRO FERTILIZATION (IVF) TREATMENT FOR VIRAL DISEASES CARRIERS: SUMMARY OF TREATMENT OUTCOME OF HIV-POSITIVE PATIENTS]. Harefuah 2017; 156:670. [PMID: 29094522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Shani Eshet
- The Rappaport Faculty of Medicine, Technion, Haifa
| | - Elena Milner
- IVF Unit, Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa
| | - Linoy Segal
- The Rappaport Faculty of Medicine, Technion, Haifa
| | - Azzam Monzer
- IVF Unit, Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa
| | - Shahar Kol
- The Rappaport Faculty of Medicine, Technion, Haifa
- IVF Unit, Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa
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Abstract
To evaluate the decrease in luteinizing hormone (LH) levels following gonadotropin-releasing hormone (GnRH) antagonist administration in in vitro fertilization (IVF) cycles, data were retrospectively collected from 305 consecutive IVF or intracytoplasmic sperm injection (ICSI) cycles of patients who underwent ovarian stimulation with gonadotropins and were treated with GnRH antagonist for the prevention of premature luteinization. We compared the percent change in LH concentration from stimulation start to that observed before ovulation triggering in patients with or without anovulation. Anovulatory patients were younger, with higher body mass index (BMI), and demonstrated higher ovarian reserve parameters as compared to ovulatory patients. The decline in LH concentration was almost two-fold greater in anovulatory versus ovulatory patients. Numbers of oocytes, fertilizations, cleavage stage embryos, and transferred embryos were similar; however, implantation rates were higher in anovulatory versus ovulatory patients. Older patients (age ≥39) showed a smaller decline in LH levels as compared to younger ones (age <39) and exhibited poor IVF outcomes. There is a wide range of pituitary responses to GnRH antagonists. Anovulatory patients are more susceptible to GnRH antagonists and therefore demonstrate over-suppression of the pituitary. Older patients demonstrate a reduced pituitary response to GnRH antagonists than younger ones. Cycle scheduling with estradiol pretreatment did not influence LH decline, nor IVF treatment outcomes.
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Affiliation(s)
- Linoy Segal
- IVF Unit, Rambam Health Care Campus, Haifa, Israel; and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Fainaru
- IVF Unit, Rambam Health Care Campus, Haifa, Israel; and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shahar Kol
- IVF Unit, Rambam Health Care Campus, Haifa, Israel; and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Hershkop E, Segal L, Fainaru O, Kol S. ‘Model’ versus ‘everyday’ patients: can randomized controlled trial data really be applied to the clinic? Reprod Biomed Online 2017; 34:274-279. [DOI: 10.1016/j.rbmo.2016.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 11/25/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
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Scher J, Joshua V, Ubeda C, Artacho A, Grunewald J, Segal L, Catrina A. AB0109 The Lung Microbiome in Rheumatoid Arthritis and Associated Local/systemic Autoimmunity. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Joshua V, Scher JU, Ubeda C, Artacho A, Segal L, Grunewald J, Catrina AI. A3.05 The lung microbiome in rheumatoid arthritis and associated local/systemic autoimmunity. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kol S, Breyzman T, Segal L, Humaidan P. ‘Luteal coasting’ after GnRH agonist trigger – individualized, HCG-based, progesterone-free luteal support in ‘high responders’: a case series. Reprod Biomed Online 2015; 31:747-51. [DOI: 10.1016/j.rbmo.2015.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/17/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
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Abstract
While the need for progesterone-based luteal phase support is well documented, the required treatment duration is not well established, and a practitioners' survey showed a wide range of empiric stopping points. It is suggested that an early stop can be based on assessing endogenous luteal activity on the day of pregnancy test. To examine this approach, data were retrospectively collected on 99 patients with positive pregnancy test and high serum concentrations of oestradiol and progesterone (≥ 1000 pmol/l and ≥ 110 nmol/l, respectively), whose luteal support was stopped, and compared with those of 85 patients who did not meet the above criteria, and so luteal support was continued until gestational week 9. Both groups were comparable in terms of live birth and miscarriage rates. We conclude that in the face of strong endogenous luteal activity, exogenous support can be stopped on pregnancy test day, without affecting pregnancy outcome. Further research is needed to substantiate this finding.
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Affiliation(s)
- Linoy Segal
- Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Tatiana Breyzman
- Department of Obstetrics and Gynecology, IVF Unit, Rambam Health Care Campus, Haifa, Israel
| | - Shahar Kol
- Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel; Department of Obstetrics and Gynecology, IVF Unit, Rambam Health Care Campus, Haifa, Israel.
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Garçon N, Silvano J, Kuper CF, Baudson N, Gérard C, Forster R, Segal L. Non-clinical safety evaluation of repeated intramuscular administration of the AS15 immunostimulant combined with various antigens in rabbits and cynomolgus monkeys. J Appl Toxicol 2015; 36:238-56. [PMID: 26032931 PMCID: PMC5033012 DOI: 10.1002/jat.3167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/11/2015] [Accepted: 04/03/2015] [Indexed: 12/31/2022]
Abstract
Combination of tumor antigens with immunostimulants is a promising approach in cancer immunotherapy. We assessed animal model toxicity of AS15 combined with various tumor antigens: WT1 (rabbits), or p501, dHER2 and recPRAME (cynomolgus monkeys), administered in seven or 20 dose regimens versus a saline control. Clinical and ophthalmological examinations, followed by extensive post‐mortem pathological examinations, were performed on all animals. Blood hematology and biochemistry parameters were also assessed. Antigen‐specific antibody titers were determined by enzyme‐linked immunosorbent assay. Additional assessments in monkeys included electrocardiography and immunohistochemical evaluations of the p501 expression pattern. Transient increases in body temperature were observed 4 h or 24 h after injections of recPRAME + AS15 and dHER2 + AS15. Edema and erythema were observed up to 1 week after most injections of recPRAME + AS15 and all injections of dHER2 + AS15. No treatment‐related effects were observed for electrocardiography parameters. Mean fibrinogen levels were significantly higher in all treated groups compared to controls, but no differences could be observed at the end of the treatment‐free period. Transient but significant differences in biochemistry parameters were observed post‐injection: lower albumin/globulin ratios (p501 + AS15), and higher bilirubin, urea and creatinine (dHER2 + AS15). Pathology examinations revealed significant increases in axillary lymph node mean weights (recPRAME + AS15) compared to controls. A 100% seroconversion rate was observed in all treated groups, but not in controls. p501 protein expression was observed in prostates of all monkeys from studies assessing p501 + AS15. These results suggest a favorable safety profile of the AS15‐containing candidate vaccines, supporting the use of AS15 for clinical development of potential anticancer vaccines. Copyright © 2015 The Authors. Journal of Applied Toxicology Published by John Wiley & Sons Ltd. The aim of the current paper was to assess the safety profile of vaccine candidates containing the AS15 immunostimulant combined with different antigens in two animal models. Several antigens were tested for this purpose: WT1 (rabbits), p501, dHER2 and recPRAME (cynomolgus monkeys). Only transient differences in hematology and biochemical parameters could be observed, while pathology testing revealed no safety concerns. Our findings support the use of AS15 for clinical development of potential immunotherapeutic cancer vaccines.
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Affiliation(s)
- N Garçon
- GSK Vaccines, 1300, Wavre, Belgium.,Bioaster, 321 Avenue Jean Jaurès, 69007, Lyon, France
| | - J Silvano
- CiToxLAB France, 27005, Evreux, France
| | - C F Kuper
- TNO Quality of Life, 3700, AJ Zeist, the Netherlands
| | - N Baudson
- GSK Vaccines, 1330 Rixensart, 1300, Wavre, Belgium
| | - C Gérard
- GSK Vaccines, 1330 Rixensart, 1300, Wavre, Belgium
| | - R Forster
- CiToxLAB France, 27005, Evreux, France
| | - L Segal
- GSK Vaccines, 1330 Rixensart, 1300, Wavre, Belgium
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Scher J, Ubeda C, Segal L, Vijay J, Artacho A, Catrina A. THU0054 The Lung Microbiome in Rheumatoid Arthritis and Local/Systemic Autoimmunity. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Destexhe E, Stannard D, Wilby OK, Grosdidier E, Baudson N, Forster R, Gérard CM, Garçon N, Segal L. Nonclinical reproductive and developmental safety evaluation of the MAGE-A3 Cancer Immunotherapeutic, a therapeutic vaccine for cancer treatment. Reprod Toxicol 2014; 51:90-105. [PMID: 25530039 DOI: 10.1016/j.reprotox.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 12/01/2014] [Accepted: 12/11/2014] [Indexed: 11/25/2022]
Abstract
We assessed potential toxic effects of the MAGE-A3 Cancer Immunotherapeutic on female fertility and embryo-fetal, pre- and post-natal development in rats and on male fertility in rats and monkeys. Three groups of 48 female (Study 1) or 22 male (Study 2) CD rats received 5 or 3 injections of 100μL of saline, AS15 immunostimulant, or MAGE-A3 Cancer Immunotherapeutic (MAGE-A3 recombinant protein combined with AS15) at various timepoints pre- or post-mating. Male Cynomolgus monkeys (Study 3) received 8 injections of 500μL of saline (n=2) or the MAGE-A3 Cancer Immunotherapeutic (n=6) every 2 weeks. Rats were sacrificed on gestation day 20 or lactation day 25 (Study 1) or 9 weeks after first injection (Study 2) and monkeys, 3 days or 8 weeks after last injection. Injections were well tolerated. Female rat mating performance or fertility, pre- and post-natal survival, offspring development up to 25 days of age, and male mating performance (rats) or fertility parameters (rats and monkeys) were unaffected.
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Affiliation(s)
- E Destexhe
- GSK Vaccines, Rue de l'Institut 89, 1330 Rixensart, Belgium
| | - D Stannard
- Huntingdon Life Sciences, Eye Research Centre, Eye, Suffolk IP23 7PX, UK
| | - O K Wilby
- Huntingdon Life Sciences, Eye Research Centre, Eye, Suffolk IP23 7PX, UK
| | | | - N Baudson
- GSK Vaccines, Rue de l'Institut 89, 1330 Rixensart, Belgium
| | - R Forster
- CiToxLAB France, BP 563, 27005 Evreux, France
| | - C M Gérard
- GSK Vaccines, Rue de l'Institut 89, 1330 Rixensart, Belgium
| | - N Garçon
- Bioaster, 321 Avenue Jean Jaurès, 69007 Lyon, France
| | - L Segal
- GSK Vaccines, Parc de la Noire Epine, Rue Fleming 20, 1300 Wavre, Belgium.
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Keystone E, Weber D, Mitroi E, Cottrell J, Segal L, Reuter H, Weber M, Mitroi P. AB1130 Real World Data on Patient Understanding and Preference in Their Biologic Treatment for Inflammatory Autoimmune Disease - A Qualitative Anonymous Patient Survey. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lenoir-Wijnkoop I, Jones PJ, Uauy R, Segal L, Milner J. Nutrition economics - food as an ally of public health. Br J Nutr 2013; 109:777-84. [PMID: 23339933 PMCID: PMC3583164 DOI: 10.1017/s0007114512005107] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 10/18/2012] [Accepted: 10/18/2012] [Indexed: 11/23/2022]
Abstract
Non-communicable diseases (NCD) are a major and increasing contributor to morbidity and mortality in developed and developing countries. Much of the chronic disease burden is preventable through modification of lifestyle behaviours, and increased attention is being focused on identifying and implementing effective preventative health strategies. Nutrition has been identified as a major modifiable determinant of NCD. The recent merging of health economics and nutritional sciences to form the nascent discipline of nutrition economics aims to assess the impact of diet on health and disease prevention, and to evaluate options for changing dietary choices, while incorporating an understanding of the immediate impacts and downstream consequences. In short, nutrition economics allows for generation of policy-relevant evidence, and as such the discipline is a crucial partner in achieving better population nutritional status and improvements in public health and wellness. The objective of the present paper is to summarise presentations made at a satellite symposium held during the 11th European Nutrition Conference, 28 October 2011, where the role of nutrition and its potential to reduce the public health burden through alleviating undernutrition and nutrition deficiencies, promoting better-quality diets and incorporating a role for functional foods were discussed.
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Affiliation(s)
- I Lenoir-Wijnkoop
- Danone Research, RD 128, 91767, Scientific Affairs, Palaiseau, France.
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Robinson PJ, Bell RJ, Lanzafame A, Segal L, Kirby C, Piterman L, Davis SR. Comparison of plain vertebral X-ray and dual-energy X-ray absorptiometry for the identification of older women for fracture prevention in primary care. Intern Med J 2013; 43:38-45. [DOI: 10.1111/j.1445-5994.2012.02930.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 07/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- P. J. Robinson
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
| | - R. J. Bell
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
| | | | - L. Segal
- Health Economics and Social Policy Group; Division of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - C. Kirby
- Research Fellow, Office of the Pro Vice-Chancellor; Monash University; Victoria
| | - L. Piterman
- Pro Vice-Chancellor (Berwick and Peninsula campuses); Monash University; Victoria
| | - S. R. Davis
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
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Lenoir-Wijnkoop I, Nuijten MJC, Gutiérrez-Ibarluzea I, Hutton J, Poley MJ, Segal L, Bresson JL, van Ganse E, Jones P, Moreno L, Salminen S, Dubois D. Workshop Report: concepts and methods in the economics of nutrition--gateways to better economic evaluation of nutrition interventions. Br J Nutr 2012; 108:1714-20. [PMID: 22947201 PMCID: PMC3513712 DOI: 10.1017/s0007114512003704] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 01/07/2023]
Abstract
Improving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutrition in health maintenance and in the prevention of non-communicable diseases is now generally recognised. However, the main scope of those seeking to contain healthcare expenditures tends to focus on the management of existing chronic diseases. Identifying additional relevant dimensions to measure and the context of use will become increasingly important in selecting and developing outcome measurements for nutrition interventions. The translation of nutrition-related research data into public health guidance raises the challenging issue of carrying out more pragmatic trials in many areas where these would generate the most useful evidence for health policy decision-making. Nutrition exemplifies all the types of interventions and policy which need evaluating across the health field. There is a need to start actively engaging key stakeholders in order to collect data and to widen health technology assessment approaches for achieving a policy shift from evidence-based medicine to evidence-based decision-making in the field of nutrition.
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Segal L, Damsten M. Strategy for the safety assessment of residuals and contaminants in vaccines. Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Day L, Finch CF, Harrison JE, Hoareau E, Segal L, Ullah S. Modelling the population-level impact of tai-chi on falls and fall-related injury among community-dwelling older people. Inj Prev 2010; 16:321-6. [DOI: 10.1136/ip.2009.025452] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
AIMS Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. METHODS This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. RESULTS Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. CONCLUSIONS Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely.
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Affiliation(s)
- M J Leach
- Health Economics and Social Policy Group, School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia.
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Peretz H, Blinder P, Segal L, Baranes D, Vago R. Erratum: Aragonite crystalline matrix as an instructive microenvironment for neural development. Journal of Tissue Engineering and Regenerative Medicine2008; 2: 463-471. J Tissue Eng Regen Med 2009. [DOI: 10.1002/term.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sivak JG, Stuart DD, Herbert KL, Van Oostrom JA, Segal L. Optical Properties of the Cultured Bovine Ocular Lens as an in Vitro Alternative to the Draize Eye Toxicity Test: Preliminary Validation for Alcohols. ACTA ACUST UNITED AC 2008. [DOI: 10.3109/15376519209050864] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dalziel K, Segal L. Time to give nutrition interventions a higher profile: cost-effectiveness of 10 nutrition interventions. Health Promot Int 2007; 22:271-83. [DOI: 10.1093/heapro/dam027] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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D'Hooghe TM, Mihalyi AM, Simsa P, Kyama CK, Peeraer K, De Loecker P, Meeuwis L, Segal L, Meuleman C. Why we need a noninvasive diagnostic test for minimal to mild endometriosis with a high sensitivity. Gynecol Obstet Invest 2006; 62:136-8. [PMID: 16679771 DOI: 10.1159/000093120] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- T M D'Hooghe
- Leuven University Fertility Center, Department of Obstetrics and Gynecology, Leuven University Hospitals, Leuven, Belgium.
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Khan SA, Wolfman JA, Segal L, Benjamin S, Nayar R, Wiley EL, Bryk M, Morrow M. Ductal lavage (DL) findings in women with mammographic microcalcifications undergoing biopsy. Ann Surg Oncol 2004. [DOI: 10.1007/bf02523993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Erol B, Segal L, Huff D, States L, Dormans JP. Low back pain in a 13-year-old girl. Clin Orthop Relat Res 2003:323-31. [PMID: 12897625 DOI: 10.1097/01.blo.0000081205.51121.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- B Erol
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th & Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
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Abstract
Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding and delivery of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model based on robust methods should become a cornerstone of Australian health system reform.
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Affiliation(s)
- S Peacock
- Health Economics Unit, Monash University, West Heidelberg, Victoria, Australia.
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Ghosh S, Watanabe RM, Hauser ER, Valle T, Magnuson VL, Erdos MR, Langefeld CD, Balow J, Ally DS, Kohtamaki K, Chines P, Birznieks G, Kaleta HS, Musick A, Te C, Tannenbaum J, Eldridge W, Shapiro S, Martin C, Witt A, So A, Chang J, Shurtleff B, Porter R, Kudelko K, Unni A, Segal L, Sharaf R, Blaschak-Harvan J, Eriksson J, Tenkula T, Vidgren G, Ehnholm C, Tuomilehto-Wolf E, Hagopian W, Buchanan TA, Tuomilehto J, Bergman RN, Collins FS, Boehnke M. Type 2 diabetes: evidence for linkage on chromosome 20 in 716 Finnish affected sib pairs. Proc Natl Acad Sci U S A 1999; 96:2198-203. [PMID: 10051618 PMCID: PMC26760 DOI: 10.1073/pnas.96.5.2198] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/1998] [Indexed: 12/22/2022] Open
Abstract
We are conducting a genome scan at an average resolution of 10 centimorgans (cM) for type 2 diabetes susceptibility genes in 716 affected sib pairs from 477 Finnish families. To date, our best evidence for linkage is on chromosome 20 with potentially separable peaks located on both the long and short arms. The unweighted multipoint maximum logarithm of odds score (MLS) was 3.08 on 20p (location, chi = 19.5 cM) under an additive model, whereas the weighted MLS was 2.06 on 20q (chi = 57 cM, recurrence risk,lambda(s) = 1. 25, P = 0.009). Weighted logarithm of odds scores of 2.00 (chi = 69.5 cM, P = 0.010) and 1.92 (chi = 18.5 cM, P = 0.013) were also observed. Ordered subset analyses based on sibships with extreme mean values of diabetes-related quantitative traits yielded sets of families who contributed disproportionately to the peaks. Two-hour glucose levels in offspring of diabetic individuals gave a MLS of 2. 12 (P = 0.0018) at 9.5 cM. Evidence from this and other studies suggests at least two diabetes-susceptibility genes on chromosome 20. We have also screened the gene for maturity-onset diabetes of the young 1, hepatic nuclear factor 4-a (HNF-4alpha) in 64 affected sibships with evidence for high chromosomal sharing at its location on chromosome 20q. We found no evidence that sequence changes in this gene accounted for the linkage results we observed.
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Affiliation(s)
- S Ghosh
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Cohen J, Piterman L, McCall LM, Segal L. Near-patient testing for serum cholesterol: attitudes of general practitioners and patients, appropriateness, and costs. Med J Aust 1998; 168:605-9. [PMID: 9673622 DOI: 10.5694/j.1326-5377.1998.tb141446.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the attitudes of general practitioners (GPs) and patients to near-patient testing (NPT) for serum cholesterol level, the appropriateness of NPT, and cost compared with testing in a specialist pathology laboratory. DESIGN A descriptive survey of registered Category 5 general practices in Victoria, 1994. Matched questionnaires were completed by GPs providing NPT and patients being tested. PARTICIPANTS 13 GPs performing NPT and 206 patients having NPT. RESULTS Thirteen of the 17 Victorian Category 5-accredited practices participated in this study (77%), and 203 of the 260 GP questionnaires and 206 of the 260 patient questionnaires were returned. NPT of serum cholesterol level was found to be appropriately used by GPs, and recommended management guidelines for lowering cholesterol level were followed. Both GPs and patients strongly supported the role of NPT in general practice on the basis of convenience, issues of patient care, quality, efficiency and cost, but GPs felt the registration and quality assurance fees were unreasonably high. We identified potential cost savings for patients and the Health Insurance Commission with NPT of cholesterol level by GPs compared with testing at specialist pathology laboratories. CONCLUSIONS NPT appears to be of benefit to both GPs and patients and to provide cost savings. However, the registration charges and quality assurance fees for NPT laboratories may be limiting GPs' use of NPT.
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Affiliation(s)
- J Cohen
- Department of Community Medicine and General Practice, Monash University, Melbourne, VIC
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Abstract
With restricted public sector budgets, there is increasing pressure to obtain value for money in the allocation of health sector resources. Distortions and inefficiencies created by features of Australia's health funding arrangements prevent health resources moving from lower valued to higher valued activities. These distortions tend to restrict resources being allocated to disease prevention and health promotional approaches, favouring medical treatment. These propositions are illustrated, largely with reference to diabetes.
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Affiliation(s)
- L Segal
- Health Economics Unit, Monash University, Melbourne, Victoria
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Abstract
Health system reform is on the agenda in Australia, across Europe and North America and elsewhere. Reform is being driven by attempts to meet ever increasing health service demands in the face of cost containment pressures. There is little agreement concerning the preferred features of health funding models. A micro-economic framework is used to define universal performance characteristics for optimal health funding arrangements. Two principle requirements emerge. These are (1) demand side reform to empower consumers and (2) supply side reform, to promote opportunities and incentives for a responsive service system and competition amongst providers. A focus on supply side issues only, without recognition of the fundamental importance of consumer empowerment will fail to promote an efficient solution to the distribution of health resources. Mechanisms to promote active consumer involvement in health care decisions are identified as a central requirement in health system reform.
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Affiliation(s)
- L Segal
- Monash University, Centre for Health Program Evaluation, West Heidelberg, Victoria, Australia.
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Easton JL, Segal L. Opportunistic screening for diabetes. Med J Aust 1998; 168:45. [PMID: 9451399 DOI: 10.5694/j.1326-5377.1998.tb123352.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Segal L, Dalton AC, Richardson J. Cost-Effectiveness of the Primary Prevention of Non-Insulin Dependent Diabetes Mellitus. Health Promot Int 1998. [DOI: 10.1093/heapro/13.3.197] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schoysman R, Lejeune B, van Roosendaal E, Segal L, Vanderzwalmen P, Nijs M, Vandamme B, Bertin G. [Medically assisted reproduction with immature spermatozoa. Clinical examination and surgical technics]. Acta Urol Belg 1997; 65:21-6. [PMID: 9324905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report their experience with the use of spermatids in TESE programs where mature spermatozoa could not be isolated from testicular biopsies. The details of the indications for spermatid insemination, the technicity of the procedure and the results are exposed.
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Affiliation(s)
- R Schoysman
- Hôpital van Helmont, Schoysman Infertility Management Foundation (S.I.M.A.F.)
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Lejeune B, Vanderzwalmen P, Vandamme B, Nijs M, Berlin G, Segal L, Vanroosendaal E, Schoysman R. O-008. Reduced implantation rate after the transfer of frozen-thawed embryos obtained by ICSI. Hum Reprod 1997. [DOI: 10.1093/humrep/12.suppl_2.3-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vanderzwalmen P, Zech H, Birkenfeld A, Yemini M, Bertin G, Lejeune B, Nijs M, Segal L, Stecher A, Vandamme B, van Roosendaal E, Schoysman R. Intracytoplasmic injection of spermatids retrieved from testicular tissue: influence of testicular pathology, type of selected spermatids and oocyte activation. Hum Reprod 1997; 12:1203-13. [PMID: 9222002 DOI: 10.1093/humrep/12.6.1203] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Spermatid microinjection into oocytes has proven to be a successful assisted reproduction procedure in the animal model and in the human species, since in the latter a few full-term pregnancies were actually obtained. Patients entering our spermatid injection study included those with a total absence of spermatozoa in the testicular tissue notwithstanding previous positive biopsies (n = 29): an obstructive problem (n = 3), secretory azoospermia (n = 26), and those with total arrest at the spermatogenesis level in previous explorative biopsies (n = 15). In the latter group, absence of spermatids was recorded in four cases. Mature, elongated, elongating and round spermatids (ROS) were injected in respectively 3, 2, 3, and 32 attempts. A total of 260 metaphase II oocytes were injected with ROS, 36 oocytes with spermatids at other stages of maturity. The rates of oocytes showing two pronuclei (2PN) and two polar bodies reached 22% and 64% respectively after injection of round or elongated-mature spermatids. The fertilization rate after ROS injection was influenced by the percentage of spermatozoa observed in a previous biopsy. Patients with a positive preliminary biopsy had significantly more 2PN (33%) when compared to those with a severe spermatogenic dysfunction and in whom no spermatozoa were found (only 11%) (P < 0.05). Incubation of oocytes in calcium ionophore after ROS injection had a positive effect on the rate of 2PN formation (36 versus 16%). Ninety per cent of all the normally fertilized oocytes cleaved. The percentage of grade A and B embryos depended on the type of injected cells: 12% after ROS and 30% with the other types of haploid cells. A total of 39 transfers resulted in five pregnancies: three full term with healthy babies delivered (one after ROS injection, and two after injection of an elongating and a mature spermatid), one 4 months ongoing (after elongating spermatid injection) and one miscarriage at 4 weeks (after elongated cell injection). Compared to our conventional intracytoplasmic sperm injection-testicular sperm extraction (ICSI-TESE) programme, the implantation rate after ROS injection was very low (5.5 versus 10.5%).
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Affiliation(s)
- P Vanderzwalmen
- Schoysman Infertility Management Foundation, Vaartsraat, Vilvoorde, Belgium
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