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Oro D, Stefanescu C, Alba M, Capitán J, Ubach A, Genovart M. Factors affecting survival and dispersal of the comma butterfly in a high mountain deciduous forest habitat. Anim Biodiv Conserv 2022. [DOI: 10.32800/abc.2023.46.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Population and community dynamics of butterflies are relatively well known in Europe thanks to citizen science and academic efforts to cover large spatio–temporal scales. However, there are still gaps of knowledge about which life–history traits have a large influence on the dynamics of particular species and the ecological factors that influence those traits. We conducted a capture–recapture demographic study on the comma butterfly Polygonia c–album in a high mountain deciduous forest. We estimated daily survival in breeding adults caught while foraging on thistles and we calculated the probability of dispersal between two close sites. Thistle growth was enhanced by nitrification in cattle grazing in the study area. Local survival was higher for males (0.920, 95 % CI: 0.851–0.959) than for females (0.869, 95 % CI: 0.799–0.917). Short–range dispersal mostly occurred in absence of wind. Light winds and high levels of solar radiation likely enhanced foraging activity. In contrast with findings in most butterfly demographic studies, recapture rates were significantly higher in females than in males, likely due to the latter moving each afternoon to establish territories along sunny forest edges away from the foraging habitat. Further demographic studies are needed to assess the effects of climate stochasticity and habitat transformation caused by changes in extensive cattle grazing on the population dynamics of the comma butterfly.
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Affiliation(s)
- D. Oro
- Centre d’Estudis Avançats de Blanes–CEAB (CSIC), Blanes, Spain
| | | | - M Alba
- Museu de Ciències Naturals de Granollers, Spain
| | - J. Capitán
- Museu de Ciències Naturals de Granollers, Spain
| | - A. Ubach
- Museu de Ciències Naturals de Granollers, Spain
| | - M. Genovart
- Centre d’Estudis Avançats de Blanes–CEAB (CSIC), Blanes, Spain
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Tabassum N, Alba M, Yan L, Voelcker NH. Porous Silicon Microneedles for Enhanced Transdermal Drug Delivery. Advanced Therapeutics 2022. [DOI: 10.1002/adtp.202200156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nazia Tabassum
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
- Faculty of Pharmacy The University of Central Punjab Jahar Town Lahore 54000 Pakistan
| | - Maria Alba
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
| | - Li Yan
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
| | - Nicolas H. Voelcker
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility Clayton Victoria 3168 Australia
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Corbera-Bellalta M, Kamberovic F, Araujo F, Alba-Rovira R, Espigol-Frigole G, Alba M, Prieto-González S, Hernández-Rodríguez J, Pérez-Galán P, Bondensgaard K, Paolini JF, Cid MC. POS0251 TRANSCRIPTOMIC CHANGES INDUCED BY MAVRILIMUMAB VERSUS TOCILIZUMAB IN EX-VIVO CULTURED ARTERIES FROM PATIENTS WITH GIANT-CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGiant cell arteritis (GCA) is a chronic disease, and affected patients suffer from relapses and glucocorticoid (GC)-related toxicity. Targeted therapies are emerging with the aim of achieving better disease control and reducing GC exposure. Blocking IL-6 receptor with tocilizumab has been a major advance in the treatment of GCA. However, approximately 40% of patients treated with tocilizumab in combination with GCs experience a flare or tocilizumab-related adverse event. Blocking GM-CSF receptor α with mavrilimumab significantly reduced risk of relapse and improved sustained remission at week 26 vs placebo in a Phase 2 trial. Not all patients satisfactorily respond to any therapy, indicating heterogeneity in leading pathogenic pathways among patients. For these reasons, it is crucial to understand the specific impact of targeted therapies on vascular lesions.ObjectivesIn this study we investigated transcriptomic changes induced by tocilizumab or mavrilimumab in ex-vivo cultured arteries from patients with GCA.MethodsTemporal artery sections obtained for diagnostic purposes from 11 patients with histopathologically-confirmed GCA and 3 controls were cultured ex-vivo and exposed to placebo, mavrilimumab, or tocilizumab (both at 20 µg/mL) for 5 days. Of 11 GCA donors, 2 had received no treatment prior to biopsy, 2 had received a single prednisone (60 mg) dose, 1 had received 2 daily doses, and the remaining 6 had extended treatment; in prednisone-treated patients, mean (SEM) treatment duration was 17.9 ±8.7 days. A separate cohort of patients (consisting of five newly diagnosed patients with GCA, age- and sex-matched with the previous cohort) was used to validate 7 transcripts by real time PCR. Genes were selected for validation based on high level of expression and differential expression with each treatment. All samples were homogenized, and total RNA was extracted with TRIzol reagent. 100 ng of RNA per sample were processed with Nanostring Inflammation gene expression assay (256 transcripts) and hybridized using nCounter Prep Station. Barcode counts from nCounter Digital Analyzer were processed with nSolver 4.0 Software. Normalised data were analyzed using R Studio 4.0.5 and IBM SPSS 22.0, and paired Wilcoxon tests were applied individually to each treatment comparison group for each analysed gene. One µg of RNA per sample from the validation cohort was retrotranscribed; subsequent real time PCRs were normalised against endogenous control GUSb and analysed using SDS 2.3 software.Results67 out of 250 transcripts were differentially expressed between arteries from GCA patients and arteries from control patients (all placebo-treated). Of those, only 9 transcripts remained significant after correction for multiple comparisons, with a false discovery rate ≤0.05. 81 transcripts were differentially expressed in at least one comparison across groups (Figure 1A). 15 transcripts were lower, and 6 were higher in the mavrilimumab group vs placebo; 3 transcripts were lower, and 2 were higher in the tocilizumab group vs placebo. Most changes elicited between treatments were unique, but CXCL-1 was common (Figure 1B). None remained significant after correction for multiple comparisons. The effects of mavrilimumab and tocilizumab on GNAS, CXCL1, IL8, IL2, IRF3, MRC1 and BCL6 expression by Nanostring were consistent with the effect assessed using real time PCR in the separate validation cohort (Figure 1C).ConclusionMavrilimumab and tocilizumab have a different transcriptomic impact on cultured arteries from patients with GCA, with some overlapping effects, although differential effects may have been attenuated by prior GC use. A better understanding of the impact of targeted therapies on vascular inflammation is needed to improve treatment options for patients with GCA.AcknowledgementsThe authors would like to thank: the Genomics core facility of the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Emily Plummer, PhD, Kiniksa Pharmaceuticals, for her invaluable contribution.The study was funded by Kiniksa Pharmaceuticals, Ltd. With support from: Fundació Clínic Barcelona, Fundació Privada Cellex, IDIBAPS, Universitat de Barcelona, Vasculitis Foundation, Marie Curie Actions, and Gobierno de España, Ministerio de Economía, Industria, y Competitividad.Disclosure of InterestsMarc Corbera-Bellalta: None declared, Farah Kamberovic: None declared, Ferran Araujo: None declared, Roser Alba-Rovira: None declared, Georgina Espigol-Frigole Consultant of: Consulting for Janssen and Hoffmann-La Roche;, Grant/research support from: Meeting attendance support from Boehringer Ingelheim, Marco Alba: None declared, Sergio Prieto-González Speakers bureau: Lecturing for Roche, Grant/research support from: Meeting attendance support from Italfarmo and CSL Behring, José Hernández-Rodríguez Speakers bureau: Lecturing for Novartis, Consultant of: Consulting for Sobi, Grant/research support from: Meeting attendance support from Sobi and Novartis, Patricia Pérez-Galán: None declared, Kent Bondensgaard Shareholder of: Kiniksa Pharmaceuticals Corp., Employee of: Kiniksa Pharmaceuticals Corp., John F. Paolini Shareholder of: Kiniksa Pharmaceuticals Corp., Employee of: Kiniksa Pharmaceuticals Corp., Maria C. Cid Speakers bureau: Educational from GSK and Vifor, Consultant of: Consulting for Janssen, GSK, and Abbvie, Grant/research support from: Research grant from Kiniksa; meeting attendance support from Roche and Kiniksa
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Marco Hernandez J, García-Martínez A, Prieto-González S, Suso A, Espígol-Frigolé G, Arguis P, Gilabert R, Alba M, Hernández-Rodríguez J, Cid MC. POS0270 DEVELOPMENT OF AORTIC ANEURYSM/DILATATION IN A PROSPECTIVE COHORT OF PATIENTS WITH BIOPSY-PROVEN GIANT-CELL ARTERITIS: EARLY IDENTIFICATION OF PATIENTS AT RISK. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUp to 10-33% of patients with giant-cell arteritis (GCA) develop aortic structural damage (ASD) (aneurysm or dilatation), typically involving the ascending aorta (1,2). Systematic use of imaging reveals radiological features of aortitis in 45-65% of patients at diagnosis (3). This finding has been associated with future aortic dilatation in retrospective studies (4).ObjectivesTo investigate the prevalence of thoracic ASD in a large prospective cohort of patients with GCA subjected to periodic imaging. To evaluate the association between features at diagnosis with ASD development.MethodsPatients were included in the study if consented, had biopsy-proven GCA and met the 1990 ACR criteria for GCA classification. Patients were prospectively followed and treated according to uniform criteria. Since 1995 patients were subjected to systematic imaging screening aimed to detect thoracic ASD. Until November 2006 it consisted of a chest X-ray that was performed at least 4 years after diagnosis and repeated every 4 years. When aortic dilatation was minimally suspected, patients underwent contrast-enhanced computed tomography (CT) scan. Since November 2006, most of patients were prospectively studied with CT angiography at diagnosis, after 1 year and every 4 years.The diagnosis of ASD was confirmed by CT, defined as an aortic diameter > 4 cm at the ascending aorta or ≥4 cm at the aortic arch or the descending aorta.Data regarding demographic characteristics, cardiovascular risk factors, GCA symptoms, laboratory tests, chronic medication at time of GCA diagnosis and corticosteroid tapering were recorded.Kaplan-Meier survival plot was used to present the cumulated incidence of thoracic ASD over time and patients were censored at the time of ASD diagnosis or at the time of the last screening in those without ASD.We also investigated which variables present at the time of GCA-diagnosis were associated with future development of ASD. Patients were classified in two groups according to whether they developed ASD or not during a follow-up period of 8 ± 1 years from the time of diagnosis.ResultsThoracic ASD was confirmed by CT in 58 patients (21.6% of the patients with systematic screening diagnosed from 1994 to 2018) after a median follow-up of 4.7 years (0.05-7.5). Ascending aorta was involved in 56 patients (96.5%), followed by the aortic arch in 11 patients (18.9%), and descending aorta in 5 (8.6%). 14 patients (24.1%) had more than 1 aortic segment involved. Figure 1 shows the number of patients with thoracic ASD detected during follow-up.Figure 1.Thoracic ASD was detected within the first 4 years from GCA-diagnosis in 19 out of the 58 patients who developed ASD (32.7%) but was severe (≥ 50 mm) in only 3 (15.8% out of those 19 patients). Most ASD was detected between 5 and 9 years after GCA-diagnosis.Patients who developed ASD during follow-up experienced less often cranial ischemic symptoms (14.8% vs 41.1%; p=0.003) or polymyalgia (33.3% vs 51.8%; p=0.057), and less frequently had a previous diagnosis of hypertension (66.7% vs 82.1%; p=0.081). Age, sex, clinical or laboratory findings or chronic therapies used at time of GCA-diagnosis were not significantly different between groups.After multivariate analysis, the presence of cranial ischemic symptoms (HR 0.180, 95% CI 0.065-0.495, p=0.001) and polymyalgia rheumatica (HR 0.329, 95% CI 0.136-0.793, p=0.013) remained inversely associated with thoracic ASD development.ConclusionASD is frequent and probably an underdiagnosed complication of GCA. There is no consensus yet regarding the optimal screening protocol during follow-up and early identification of patients at risk is crucial for this purpose. The presence of cranial ischemic symptoms or polymyalgia rheumatica were inversely associated with thoracic ASD development in our prospective cohort.References[1]García-Martínez A et al. Ann Rheum Dis 2014.[2]Evans JM et al. Ann Intern Med 1995.[3]Prieto-González S et al. Ann Rheum Dis 2012.[4]Blockmans D et al. Rheumatology (Oxford) 2008.AcknowledgementsBoth first co-authors contributted equally to this work.The research was supported MTV3 2014/20150730Disclosure of InterestsNone declared
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Guo K, Alba M, Chin GP, Tong Z, Guan B, Sailor MJ, Voelcker NH, Prieto-Simón B. Designing Electrochemical Biosensing Platforms Using Layered Carbon-Stabilized Porous Silicon Nanostructures. ACS Appl Mater Interfaces 2022; 14:15565-15575. [PMID: 35286082 PMCID: PMC9682479 DOI: 10.1021/acsami.2c02113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Porous silicon (pSi) is an established porous material that offers ample opportunities for biosensor design thanks to its tunable structure, versatile surface chemistry, and large surface area. Nonetheless, its potential for electrochemical sensing is relatively unexplored. This study investigates layered carbon-stabilized pSi nanostructures with site-specific functionalities as an electrochemical biosensor. A double-layer nanostructure combining a top hydrophilic layer of thermally carbonized pSi (TCpSi) and a bottom hydrophobic layer of thermally hydrocarbonized pSi (THCpSi) is prepared. The modified layers are formed in a stepwise process, involving first an electrochemical anodization step to generate a porous layer with precisely defined pore morphological features, followed by deposition of a thin thermally carbonized coating on the pore walls via temperature-controlled acetylene decomposition. The second layer is then generated beneath the first by following the same two-step process, but the acetylene decomposition conditions are adjusted to deposit a thermally hydrocarbonized coating. The double-layer platform features excellent electrochemical properties such as fast electron-transfer kinetics, which underpin the performance of a TCpSi-THCpSi voltammetric DNA sensor. The biosensor targets a 28-nucleotide single-stranded DNA sequence with a detection limit of 0.4 pM, two orders of magnitude lower than the values reported to date by any other pSi-based electrochemical DNA sensor.
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Affiliation(s)
- Keying Guo
- Monash
Institute of Pharmaceutical Sciences, Monash
University, Parkville, Victoria 3052, Australia
- Melbourne
Centre for Nanofabrication, Victorian Node
of the Australian National Fabrication Facility, Clayton, Victoria 3168, Australia
| | - Maria Alba
- Monash
Institute of Pharmaceutical Sciences, Monash
University, Parkville, Victoria 3052, Australia
- Melbourne
Centre for Nanofabrication, Victorian Node
of the Australian National Fabrication Facility, Clayton, Victoria 3168, Australia
- Commonwealth
Scientific and Industrial Research Organisation (CSIRO), Clayton, Victoria 3168, Australia
| | - Grace Pei Chin
- Monash
Institute of Pharmaceutical Sciences, Monash
University, Parkville, Victoria 3052, Australia
| | - Ziqiu Tong
- Monash
Institute of Pharmaceutical Sciences, Monash
University, Parkville, Victoria 3052, Australia
| | - Bin Guan
- Future
Industries Institute, University of South
Australia, Mawson
Lakes, South Australia 5095, Australia
| | - Michael J. Sailor
- Department
of Chemistry and Biochemistry and Department of Nanoengineering, University of California, San Diego, La Jolla, California 92093-0358, United States
| | - Nicolas H. Voelcker
- Monash
Institute of Pharmaceutical Sciences, Monash
University, Parkville, Victoria 3052, Australia
- Melbourne
Centre for Nanofabrication, Victorian Node
of the Australian National Fabrication Facility, Clayton, Victoria 3168, Australia
- Commonwealth
Scientific and Industrial Research Organisation (CSIRO), Clayton, Victoria 3168, Australia
| | - Beatriz Prieto-Simón
- Department
of Electronic Engineering, Universitat Rovira
i Virgili, Tarragona 43007, Spain
- ICREA, Pg. Lluís Companys 23, Barcelona 08010, Spain
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Dervisevic M, Alba M, Esser L, Tabassum N, Prieto-Simon B, Voelcker NH. Silicon Micropillar Array-Based Wearable Sweat Glucose Sensor. ACS Appl Mater Interfaces 2022; 14:2401-2410. [PMID: 34968024 DOI: 10.1021/acsami.1c22383] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Wearable technologies have great potential in health monitoring and disease diagnostics. As a consequence, interest in the study of wearable sensors has dramatically increased over recent years. Successful translation of this technology from research prototypes to commercial products requires addressing some of the major challenges faced by wearable sensors such as loss of, and damage in, the biological recognition layer of the skin-interfaced sensors. In this work, we propose a solution to this challenge by integrating micropillar array (MPA) surfaces as part of the sensing layer with the aim to protect and prevent the loss of the enzyme layer from mechanical stress while the sensor is worn. The proposed wearable sensing patch is composed of reference, counter, and working electrodes, all made of MPAs and is designed for measuring glucose in sweat. MPA sensing patch has a wide linear range of 50 μM to 1.4 mM, a sensitivity of 4.7 ± 0.8 μA mM-1, and a limit of detection of 26 ± 5 μM. The glucose sensing patch was tested using human sweat where glucose-level changes were successfully measured before and after meal consumption. The developed patch provides an alternative solution to the problem of the damage to the sensor microenvironment upon wear. But in addition, it also offers a user-friendly, cost-effective, and reliable sweat analysis platform with significant potential in health monitoring applications.
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Affiliation(s)
- Muamer Dervisevic
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Maria Alba
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
- Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria 3168, Australia
| | - Lars Esser
- Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria 3168, Australia
| | - Nazia Tabassum
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Beatriz Prieto-Simon
- Department of Electronic Engineering, Universitat Rovira i Virgili, Tarragona 43007, Spain
| | - Nicolas H Voelcker
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
- Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria 3168, Australia
- Melbourne Centre for Nanofabrication, Victorian Node of the Australian National Fabrication Facility, Clayton, Victoria 3168, Australia
- Materials Science and Engineering, Monash University, Clayton, Victoria 3168, Australia
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Chen Y, Alba M, Tieu T, Tong Z, Minhas RS, Rudd D, Voelcker NH, Cifuentes-Rius A, Elnathan R. Engineering Micro–Nanomaterials for Biomedical Translation. Adv NanoBio Res 2021. [DOI: 10.1002/anbr.202100002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Yaping Chen
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton VIC 3168 Australia
| | - Maria Alba
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton VIC 3168 Australia
| | - Terence Tieu
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing Commonwealth Scientific and Industrial Research Organisation (CSIRO) Clayton VIC 3168 Australia
| | - Ziqiu Tong
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
| | - Rajpreet Singh Minhas
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton VIC 3168 Australia
| | - David Rudd
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton VIC 3168 Australia
| | - Nicolas H. Voelcker
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton VIC 3168 Australia
- Department of Materials Science and Engineering Monash University 22 Alliance Lane Clayton VIC 3168 Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing Commonwealth Scientific and Industrial Research Organisation (CSIRO) Clayton VIC 3168 Australia
- INM-Leibniz Institute for New Materials Campus D2 2 Saarbrücken 66123 Germany
| | - Anna Cifuentes-Rius
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
| | - Roey Elnathan
- Monash Institute of Pharmaceutical Sciences Monash University 381 Royal Parade Parkville VIC 3052 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton VIC 3168 Australia
- Department of Materials Science and Engineering Monash University 22 Alliance Lane Clayton VIC 3168 Australia
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Dervisevic M, Alba M, Adams TE, Prieto-Simon B, Voelcker NH. Electrochemical immunosensor for breast cancer biomarker detection using high-density silicon microneedle array. Biosens Bioelectron 2021; 192:113496. [PMID: 34274623 DOI: 10.1016/j.bios.2021.113496] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 06/11/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
Electrochemical devices for transdermal monitoring of key biomarkers are the potential next frontier of wearable technologies for point-of-care disease diagnosis, including Cancer in which Cancer is the leading cause of death worldwide with estimated 10 million deaths in 2018 according to the World Health Organization and breast cancer is one of the five most common causes of cancer death with over two million cases recorded in 2018. Early diagnosis and prognosis based on monitoring of breast cancer biomarkers is of high importance. In this work, high-density gold coated silicon microneedle arrays (Au-Si-MNA) were simultaneously used as biomarker extraction platform and electrochemical transducer, enabling the selective immunocapture of epidermal growth factor receptor 2 (ErbB2), a key breast cancer biomarker, and its subsequent quantification. The analytical performance of the device was tested in artificial interstitial fluid exhibiting a linear response over a wide concentration range from 10 to 250 ng/mL, with a detection limit of 4.8 ng/mL below the biomarker levels expected in breast cancer patients. As a proof of concept, the immunosensor demonstrated its ability to successfully extract ErbB2 from a phantom gel mimicking the epidermis and dermis layers, and subsequently quantify it showing a linear range from 50 to 250 ng/mL and a detection limit of 25 ng/mL. The uniqueness of this sensing platform combining direct transdermal biomarker extraction and quantification opens up new avenues towards the development of high performing wearable point-of-care devices.
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Affiliation(s)
- Muamer Dervisevic
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia
| | - Maria Alba
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia; Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, 3168, Australia
| | - Timothy E Adams
- Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, 3168, Australia
| | - Beatriz Prieto-Simon
- Department of Electronic Engineering, Universitat Rovira i Virgili, 43007, Tarragona, Spain; ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
| | - Nicolas H Voelcker
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, 3052, Australia; Commonwealth Scientific and Industrial Research Organization (CSIRO), Clayton, Victoria, 3168, Australia; Melbourne Centre for Nanofabrication, Victorian Node of the Australian National Fabrication Facility, Clayton, Victoria, 3168, Australia; Materials Science and Engineering, Monash University, Clayton, Victoria, 3168, Australia.
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Di Prospero NA, Yee J, Frustaci ME, Samtani MN, Alba M, Fleck P. Efficacy and safety of glucagon-like peptide-1/glucagon receptor co-agonist JNJ-64565111 in individuals with type 2 diabetes mellitus and obesity: A randomized dose-ranging study. Clin Obes 2021; 11:e12433. [PMID: 33475251 DOI: 10.1111/cob.12433] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Received: 08/21/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 12/15/2022]
Abstract
Weight loss has been shown to improve metabolic parameters and cardiovascular risk in people with type 2 diabetes mellitus (T2DM). This phase 2 study evaluated the safety and efficacy of JNJ-64565111, a dual agonist of GLP-1 and glucagon receptors, in individuals with T2DM and class II/III obesity. In this randomized, double-blind study, participants with T2DM (HbA1c 6.5%-9.5%), body mass index of 35 to 50 kg/m2 and stable weight were randomly assigned (1:1:1:1) to placebo or JNJ-64565111 (5.0 mg, 7.4 mg or 10.0 mg). The primary endpoint was percent change from baseline in body weight at week 12. Of 195 dosed participants, 144 (73.8%) completed treatment. At week 12, placebo-subtracted body weight changes were -4.6%, -5.9% and -7.2% with JNJ-64565111 5.0 mg, 7.4 mg and 10.0 mg, respectively. All JNJ-64565111 doses were associated with no change in HbA1c and slight numerical elevation of fasting insulin. Numerical increases in fasting plasma glucose were observed with JNJ-64565111 5.0 mg and 7.4 mg. Incidence of treatment-emergent adverse events, especially nausea and vomiting, was higher with JNJ-64565111 vs placebo. Overall, JNJ-64565111 significantly reduced body weight in a dose-dependent manner vs placebo but was associated with greater incidence of treatment-emergent adverse events, no HbA1c reductions, and increased fasting plasma glucose and fasting insulin.
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Affiliation(s)
| | - Jaqueline Yee
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
| | - Mary E Frustaci
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | | | - Maria Alba
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
| | - Penny Fleck
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
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Alba M, Yee J, Frustaci ME, Samtani MN, Fleck P. Efficacy and safety of glucagon-like peptide-1/glucagon receptor co-agonist JNJ-64565111 in individuals with obesity without type 2 diabetes mellitus: A randomized dose-ranging study. Clin Obes 2021; 11:e12432. [PMID: 33475255 DOI: 10.1111/cob.12432] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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] [Received: 08/21/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 01/05/2023]
Abstract
Individuals with obesity have a heightened risk of developing serious comorbidities, and pharmacological treatments for people with obesity are limited. This phase 2 study assessed the safety and efficacy of JNJ-64565111, a dual agonist of glucagon-like peptide-1 and glucagon receptors, in individuals with class II/III obesity without type 2 diabetes. In this randomized, double-blind, placebo-controlled and open-label active-controlled, parallel-group, multicentre study, participants aged 18 to 70 years with a body mass index of 35 to 50 kg/m2 and stable weight were randomly assigned in a 1:1:2:2:2 ratio to blinded treatment with placebo; JNJ-64565111 (5.0, 7.4 or 10.0 mg, each with no dose escalation), or open-label liraglutide 3.0 mg. The primary efficacy endpoint was percent change from baseline in body weight at week 26. Four-hundred seventy four participants were randomized and 343 (72.4%) completed treatment. At week 26, placebo-subtracted body weight changes (adjusted for multiplicity) were -6.8%, -8.1% and -10.0% for the JNJ-64565111 5.0 mg, 7.4 mg and 10.0 mg groups, respectively, and -5.8% for the liraglutide group. Incidence of treatment-emergent adverse events, especially nausea and vomiting, was higher in each JNJ-64565111 treatment group compared to placebo and liraglutide. JNJ-64565111 significantly reduced body weight in a dose-dependent manner vs placebo but was associated with greater incidence of treatment-emergent adverse events.
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Affiliation(s)
- Maria Alba
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
| | - Jaqueline Yee
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
| | | | | | - Penny Fleck
- Janssen Research & Development, LLC, Raritan, New Jersey, USA
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Matthews DR, Wysham C, Davies M, Slee A, Alba M, Lee M, Perkovic V, Mahaffey KW, Neal B. Effects of canagliflozin on initiation of insulin and other antihyperglycaemic agents in the CANVAS Program. Diabetes Obes Metab 2020; 22:2199-2203. [PMID: 32691499 PMCID: PMC7693248 DOI: 10.1111/dom.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023]
Abstract
This study compared initiation of insulin and other antihyperglycaemic agents (AHAs) with canagliflozin versus placebo for participants with type 2 diabetes and a history/high risk of cardiovascular disease in the CANagliflozin cardioVascular Assessment Study (CANVAS) Program. After 1 year, fewer participants treated with canagliflozin versus placebo initiated any AHA (7% vs. 16%), insulin (3% vs. 9%) or any non-insulin AHA (5% vs. 12%) (P < .001 for all); overall AHA initiation rates increased over time but were consistently lower with canagliflozin compared with placebo. During the study, the likelihood of initiating insulin was 2.7 times lower for participants treated with canagliflozin compared with placebo (hazard ratio, 0.37; 95% CI: 0.31, 0.43; P < .001). The time difference between 10% of patients in the canagliflozin and placebo groups being initiated on insulin from the beginning of the trial was about 2 years. Time to initiation of other AHAs, including metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sulphonylureas, was also delayed for canagliflozin versus placebo (P < .001 for each). Compared with placebo, canagliflozin delayed the need for initiation of other AHAs and delayed time to insulin therapy, an outcome that is important to many people with diabetes.
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Affiliation(s)
- David R. Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism and Harris Manchester CollegeUniversity of OxfordOxfordUK
| | | | - Melanie Davies
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
| | | | - Maria Alba
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Mary Lee
- Janssen Research & Development, LLCRaritanNew JerseyUSA
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW SydneySydneyNew South WalesAustralia
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Bruce Neal
- The George Institute for Global Health, UNSW SydneySydneyNew South WalesAustralia
- The Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- Imperial College LondonLondonUK
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Fernandes Serodio J, Hernández-Rodríguez J, Espígol-Frigolé G, Alba M, Marco-Hernández J, Sánchez M, Hernández-González F, Sellarés J, Cid MC, Prieto-González S. THU0305 PREVALENCE AND CLINICAL OUTCOME OF INTERSTITIAL LUNG DISEASE IN ANCA ASSOCIATED VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Lung involvement is frequent in ANCA-associated vasculitis (AAV). Classical lung manifestations consist of capillaritis with lung haemorrhage, inflammatory infiltrates and nodules. Interstitial lung disease (ILD) is increasingly recognized among patients with AAV. However, little is known concerning risk factors and clinical course of these patients.Objectives:The aim of our study was to characterize the prevalence and clinical course of ILD in patients with AAV.Methods:We have performed a clinical retrospective single-centre observational analysis (1990-2019) of all patients with the diagnosis of microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) diagnosed according to 2018 Draft Classification Criteria for GPA and MPA1. Demographic, clinical and immunologic data were reviewed. Radiologic pattern of ILD were assessed by high-resolution-CT. Main outcome evaluated was overall-all survival.Results:The study population consisted of 123 patients, 56% female, aged 59.3±18.2 years old at the time of diagnosis. Clinical diagnosis was of MPA in 54% of patients and GPA in 46%. While 108 (88%) ANCA positive patients had PR3 (n=25) or MPO (n=83), 15 (12%) patients had negative or atypical ANCA. Any lung involvement was present in 82 (71%) and ILD was identified in 24 (20%) of all patients. ILD pattern was of usual interstitial pneumonia (UIP) in 12 patients, non-specified interstitial pneumonia (NSIP) in 9 and chronic organizing pneumonia (OP) in 3. There was an association between the presence of ILD and ANCA specificity: MPO were present in 100% of patients with UIP and in 75% of patients with NSIP/OP (p=0.017). Bronchiectasis were more prevalent among patients with ILD (19/24; p<0.001). During the median follow-up time period of 68 (23-126) months, mortality was of 42% among patients with ILD-AAV compared with 11% in no ILD-AAV (log-rank p=0.0001). On the multivariate Cox regression model, ILD was an independent predictor of mortality HR 2.95 (95%CI 1.09-7.96; p=0.033).Conclusion:ILD is a frequent manifestation of MPA and GPA patients. The presence of ILD, particularly UIP, is associated with ANCA-MPO and is a predictor of mortality. Therefore, a better management of fibrotic lung involvement in AAV is warranted.References:[1]Robson JC, Grayson PC, Ponte C, et al. Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.Disclosure of Interests:João Fernandes Serodio: None declared, José Hernández-Rodríguez: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Marcelo Sánchez: None declared, Fernanda Hernández-González: None declared, Jacobo Sellarés: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, Sergio Prieto-González: None declared
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Fernandes Serodio J, Prieto-González S, Espígol-Frigolé G, Alba M, Marco-Hernández J, Cid MC, Hernández-Rodríguez J. AB0475 CLINICAL RELEVANCE OF CLINICOPATHOLOGICAL PHENOTYPE AND ANTIBODY SPECIFICITY IN ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Classification of ANCA-associated vasculitis (AAV) has emerged in order to identify more homogenous subgroups of patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). However, the exact value of classifying patients according to antibody specificity (proteinase 3 [PR3] or myeloperoxidase [MPO]) is still unclear.Objectives:To assess demographic, clinical and prognostic differences among subgroups of AAV patients, according to clinicopathological classification (GPAvs. MPA) and antibody specificity (PR3vs. MPO) in a single-centre cohort.Methods:A clinical retrospective (1990-2019) observational analysis was performed. Among all patients with ANCA positivity, we analysed patients with GPA and MPA diagnosed according to 2018 Draft Classification Criteria for AAV1, who were homogeneously treated and followed by the authors. Demographic, clinical and laboratory data, as well as disease outcomes, particularly BVAS, disease relapses and survival, were reviewed.Results:Among a total 140 patients with any form of AAV, 32 were excluded for a diagnosis of isolated interstitial lung disease (n=10), cocaine-induced AAV (n=3), ANCA negative or undetermined disease (n=16), atypical ANCA or double PR3/MPO positivity (n=3). Finally, 108 patients with MPA (n=66) or GPA (n=42) were included (83 MPO, 25 PR3). GPA was associated with PR3 in 55% and MPO 45% of patients. MPA was associated with MPO in 97% and PR3 in 3% of patients. GPA patients with PR3 or MPO presented with similar clinical features, disease extent and BVAS. However, compared with GPA/PR3, GPA/MPO were more frequently women (p=0.002). MPA patients presented more frequent with renal involvement (p=0.008) and GPA patients with ENT/ocular involvement (p<0.001). Patients with MPO were older (p=0.028) and more frequently women (p=0.001) than PR3 patients. When antibody specificity was compared, differences on organ-specific manifestations were less clear than between clinical phenotypes (GPA vs. MPA), and were only seen in ENT/ocular involvement (more frequent in PR3 than in MPO patients) and in muscle biopsies disclosing vasculitis (more frequent in MPO than in PR3 patients). GPA and PR3 patients presented more frequent relapsing disease than MPA and MPO patients, respectively (GPA 60% vs. MPA 36%; p=0.018 / PR3 60% vs. MPO 41%; p=0.094). While GPA tended to have a better survival rate than MPA patients (p=0.066) (Graph1), the MPO-associated disease (GPA or MPA) had clearly worse survival prognosis than PR3-AAV (p=0.008) (Graph2), similarly to what occurred in GPA-MPO (compared with GPA-PR3).Conclusion:A high proportion of GPA patients with MPO-ANCA (45%) is observed in our series. GPA is associated with a more frequent relapsing disease than MPA. MPA and presence of MPO were more frequent in females and older patients. Clinical features were similar in GPA patients with PR3 or MPO. The presence of MPO (in GPA or MPA) seems to be the main factor associated with mortality in AAV.Table 1.Symptomatology and ultrasound findings in the patients examined. PMR: Polymyalgia RheumaticaUltrasoundSymptomsCranial(n=17)PMR only(n=17)Non-specific symptoms (n=18)PMR (+) (n=7)PMR (-) (n=10)Temporal (+)7301Facial (+)2100Axilliary (+)0031References:[1]Robson JC, Grayson PC, Ponte C, et al.Draft classification criteria for the ANCA associated vasculitides. Ann Rheum Dis 2018;77 (suppl 2):60-1.Disclosure of Interests:João Fernandes Serodio: None declared, Sergio Prieto-González: None declared, Georgina Espígol-Frigolé: None declared, Marco Alba: None declared, Javier Marco-Hernández: None declared, Maria C. Cid Grant/research support from: Kiniksa Pharmaceuticals, Consultant of: Janssen, Abbvie, Roche, GSK, Speakers bureau: Vifor, José Hernández-Rodríguez: None declared
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Affiliation(s)
- Li Yan
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing Clayton Victoria 3168 Australia
| | - Maria Alba
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing Clayton Victoria 3168 Australia
| | - Nazia Tabassum
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
- The University of Central Punjab Johar Town Lahore 54000 Pakistan
| | - Nicolas H. Voelcker
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Victoria 3052 Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing Clayton Victoria 3168 Australia
- Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility Clayton Victoria 3168 Australia
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15
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Wang L, Voss EA, Weaver J, Hester L, Yuan Z, DeFalco F, Schuemie MJ, Ryan PB, Sun D, Freedman A, Alba M, Lind J, Meininger G, Berlin JA, Rosenthal N. Diabetic ketoacidosis in patients with type 2 diabetes treated with sodium glucose co-transporter 2 inhibitors versus other antihyperglycemic agents: An observational study of four US administrative claims databases. Pharmacoepidemiol Drug Saf 2019; 28:1620-1628. [PMID: 31456304 PMCID: PMC6916409 DOI: 10.1002/pds.4887] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 03/26/2019] [Revised: 07/01/2019] [Accepted: 07/25/2019] [Indexed: 01/10/2023]
Abstract
Purpose To compare the incidence of diabetic ketoacidosis (DKA) among patients with type 2 diabetes mellitus (T2DM) who were new users of sodium glucose co‐transporter 2 inhibitors (SGLT2i) versus other classes of antihyperglycemic agents (AHAs). Methods Patients were identified from four large US claims databases using broad (all T2DM patients) and narrow (intended to exclude patients with type 1 diabetes or secondary diabetes misclassified as T2DM) definitions of T2DM. New users of SGLT2i and seven groups of comparator AHAs were matched (1:1) on exposure propensity scores to adjust for imbalances in baseline covariates. Cox proportional hazards regression models, conditioned on propensity score‐matched pairs, were used to estimate hazard ratios (HRs) of DKA for new users of SGLT2i versus other AHAs. When I2 <40%, a combined HR across the four databases was estimated. Results Using the broad definition of T2DM, new users of SGLT2i had an increased risk of DKA versus sulfonylureas (HR [95% CI]: 1.53 [1.31‐1.79]), DPP‐4i (1.28 [1.11‐1.47]), GLP‐1 receptor agonists (1.34 [1.12‐1.60]), metformin (1.31 [1.11‐1.54]), and insulinotropic AHAs (1.38 [1.15‐1.66]). Using the narrow definition of T2DM, new users of SGLT2i had an increased risk of DKA versus sulfonylureas (1.43 [1.01‐2.01]). New users of SGLT2i had a lower risk of DKA versus insulin and a similar risk as thiazolidinediones, regardless of T2DM definition. Conclusions Increased risk of DKA was observed for new users of SGLT2i versus several non‐SGLT2i AHAs when T2DM was defined broadly. When T2DM was defined narrowly to exclude possible misclassified patients, an increased risk of DKA with SGLT2i was observed compared with sulfonylureas.
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Affiliation(s)
- Lu Wang
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Erica A Voss
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - James Weaver
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Laura Hester
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Zhong Yuan
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Frank DeFalco
- Janssen Research & Development, LLC, Raritan, New Jersey
| | | | - Patrick B Ryan
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Don Sun
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Amy Freedman
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Maria Alba
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Joan Lind
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Gary Meininger
- Janssen Research & Development, LLC, Raritan, New Jersey
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Fastenau J, Kolotkin RL, Fujioka K, Alba M, Canovatchel W, Traina S. A call to action to inform patient-centred approaches to obesity management: Development of a disease-illness model. Clin Obes 2019; 9:e12309. [PMID: 30977293 PMCID: PMC6594134 DOI: 10.1111/cob.12309] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
Patient-centred care is an essential component of high-quality health care, shown to improve clinical outcomes and patient satisfaction, and reduce costs. While there are several authoritative models of obesity pathophysiology and treatment algorithms, a truly patient-centred model is lacking. We describe the development of a patient-centric obesity model. A disease-illness framework was selected because it emphasizes each patient's unique experience while capturing biomedical aspects of the disease. Model input was obtained from an accumulation of research including contributions from experts in obesity and patient-reported outcomes, qualitative research with adults living in the United States, and two targeted literature searches. The model places the patient with obesity at its core and links pathologic imbalances of energy intake and expenditure to environmental, sociodemographic, psychological, behavioural, physiological and medical health determinants. It highlights relationships between obesity signs and symptoms, comorbid conditions, impacts on health-related quality of life, and some barriers to obesity management that must be considered to attain better outcomes. Providers need to evaluate patients holistically, understand what changes each patient is motivated to make, and recognize what challenges might impede weight reduction, improvements in comorbid conditions, signs and symptoms, and health-related quality of life before pursuing individualized treatment goals. Patients living with obesity who do lose weight perceive benefits beyond weight loss. Ideally, this model will increase awareness of the complex, heterogeneous impacts of obesity on patients' well-being and recognition of obesity as a chronic disease, and prompt a call to action among stakeholders to improve quality of care.
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Affiliation(s)
- John Fastenau
- Janssen Research & Development, LLCRaritanNew Jersey
| | - Ronette L. Kolotkin
- Quality of Life Consulting, PLLCDurhamNorth Carolina
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth Carolina
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFørdeNorway
- Centre of Health ResearchFørde Hospital TrustFørdeNorway
- Morbid Obesity CentreVestfold Hospital TrustTønsbergNorway
| | - Ken Fujioka
- Department of Diabetes and EndocrineScripps ClinicSan DiegoCalifornia
| | - Maria Alba
- Janssen Research & Development, LLCRaritanNew Jersey
| | | | - Shana Traina
- Janssen Research & Development, LLCRaritanNew Jersey
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Bueno-Campaña M, Sainz T, Alba M, Del Rosal T, Mendez-Echevarría A, Echevarria R, Tagarro A, Ruperez-Lucas M, Herrreros ML, Latorre L, Calvo C. Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: A cohort study. Pediatr Pulmonol 2019; 54:873-880. [PMID: 30838805 DOI: 10.1002/ppul.24287] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Respiratory tract infections are among the most common causes of morbidity and mortality worldwide. Acute bronchiolitis (AB) is the leading cause of hospital admission among infants. Clinical scores have proven to be inaccurate in predicting prognosis. Our aim was to build a score based on findings of lung ultrasound (LU) performed at admission, to stratify patients at risk of needing respiratory support (non-invasive and invasive ventilation). STUDY DESIGN Prospective, multicenter study including infants <6 months of age admitted with AB. Point-of-care LU was performed on admission, and a score was calculated based on ultrasound findings (presence and localization of B lines, B line confluence and/or consolidations) and clinical data. Main outcome was need of respiratory support. RESULTS A total of 145 patients were included in the study, with a median age of 1.7 months [IQR: 1.2-2.8], 47.6% were female. Mean duration of symptoms prior to admission was 3.1 days (SD 1.8). Fifty-six patients (39%) required non-invasive ventilation (NIV), 14 (9.7%) were transferred to PICU, and 3 needed invasive ventilation (3/145). Identification of at least one posterior consolidation >1 cm was the main factor associated to NIV (RR 4.4; [CI95%1.8-10.8]) The LU score built according to the findings on admission showed an AUC: 0.845(CI95%:0.78-0.91). A score ≥3.5 showed a sensitivity of 89.1% (CI95%:78.2-94.9%) and specificity of 56% (CI95%: 45.3-66.1%) CONCLUSIONS: Among infants below 6 months of age admitted with AB, point-of-care LU was a helpful tool to identify patients at risk of needing respiratory support.
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Affiliation(s)
- Mercedes Bueno-Campaña
- Department of Pediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Talía Sainz
- Department of Pediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Translational Research Network for Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Maria Alba
- Department of Pediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Teresa Del Rosal
- Department of Pediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Translational Research Network for Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Ana Mendez-Echevarría
- Department of Pediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Translational Research Network for Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Regina Echevarria
- Department of Pediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Alfredo Tagarro
- Translational Research Network for Pediatric Infectious Diseases (RITIP), Madrid, Spain.,Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | - Marta Ruperez-Lucas
- Department of Pediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Maria L Herrreros
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Libertad Latorre
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Translational Research Network for Pediatric Infectious Diseases (RITIP), Madrid, Spain.,TEDDY Network Member (European Network of Excellence for Pediatric Clinical Research), Bari, Italy
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Wang L, Voss EA, Weaver J, Hester L, Yuan Z, DeFalco F, Schuemie MJ, Ryan PB, Sun D, Freedman A, Alba M, Lind J, Meininger G, Berlin JA, Rosenthal N. Abstract 24: Diabetic Ketoacidosis in Patients with Type 2 Diabetes Treated with Sodium Glucose Co-transporter 2 Inhibitors versus Other Antihyperglycemic Agents: An Observational Study of Four US Administrative Claims Databases. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Diabetic ketoacidosis (DKA) is a serious acute metabolic complication of diabetes. Rare DKA events have occurred in patients taking sodium glucose co-transporter 2 inhibitors (SGLT2i). This study evaluated the risk of DKA in patients with type 2 diabetes mellitus (T2DM) taking SGLT2i versus other antihyperglycemic agents (AHAs) in clinical practice.
Methods:
This study, per protocol reviewed and approved by the European Medicines Agency, identified patients from 4 large US claims databases using broad and narrow definitions of T2DM; the broad definition captured all patients with a T2DM diagnosis and the narrow definition was intended to exclude T1DM misclassified as T2DM. DKA was identified from diagnosis codes in inpatient or emergency room claims. Eligible new users of SGLT2i and 7 groups of AHA comparators were matched (1:1) on exposure propensity scores (PS) to adjust for imbalances in baseline covariates. Cox proportional hazard models conditioned on PS-matched pairs were used to estimate hazard ratios (HR) of DKA risk for new users of SGLT2i versus other AHAs.
P
values were calibrated using negative control outcomes to address potential residual bias. Pooled HRs were calculated when I
2
was <40% across 4 databases.
Results:
The number of new users of SGLT2i in each database ranged from 11,141 to 152,728 using the broad T2DM definition and from 7,779 to 130,708 using the narrow definition. Across databases, the unadjusted incidence rates of DKA (events per 1000 patient-years) ranged from 2.75 to 8.84 with SGLT2i and 1.38 to 15.82 with other AHAs using the broad T2DM definition and from 1.15 to 3.91 with SGLT2i and 0.75 to 7.94 with other AHAs using the narrow definition. Using the broad T2DM definition, a significantly increased risk of DKA was observed among new users of SGLT2i versus 5 groups of other AHAs; when using the narrow definition, an increased risk of DKA with SGLT2i was observed only compared with sulfonylureas (
Figure
).
Conclusion:
In this claims database study, an increased risk of DKA was observed for new users of SGLT2i versus new users of several non-SGLT2i AHAs when T2DM was defined broadly. When T2DM was defined narrowly to exclude possible misdiagnosed T1DM patients, an increased risk of DKA with SGLT2i was observed compared to sulfonylureas.
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Affiliation(s)
- Lu Wang
- Janssen Rsch & Development, LLC, Titusville, NJ
| | | | | | | | - Zhong Yuan
- Janssen Rsch & Development, LLC, Titusville, NJ
| | | | | | | | - Don Sun
- Janssen Rsch & Development, LLC, Titusville, NJ
| | | | - Maria Alba
- Janssen Rsch & Development, LLC, Raritan, NJ
| | - Joan Lind
- Janssen Rsch & Development, LLC, Raritan, NJ
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Tieu T, Alba M, Elnathan R, Cifuentes-Rius A, Voelcker NH. Theranostics: Advances in Porous Silicon-Based Nanomaterials for Diagnostic and Therapeutic Applications (Adv. Therap. 1/2019). Adv Therap 2019. [DOI: 10.1002/adtp.201970001] [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: 11/06/2022]
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Alba M, Robin M, Menzies D, Gengenbach TR, Prieto-Simon B, Voelcker NH. Differential functionalisation of the internal and external surfaces of carbon-stabilised nanoporous silicon. Chem Commun (Camb) 2019; 55:8001-8004. [DOI: 10.1039/c9cc03755a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A versatile strategy to differentiate the surface chemistry of the internal and external pore walls of highly-stable nanoporous silicon.
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Affiliation(s)
- Maria Alba
- Monash Institute of Pharmaceutical Sciences
- Monash University
- Parkville
- Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing
| | - Morgane Robin
- Future Industries Institute
- University of South Australia
- Mawson Lakes
- Australia
| | - Donna Menzies
- Monash Institute of Pharmaceutical Sciences
- Monash University
- Parkville
- Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing
| | - Thomas R. Gengenbach
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing
- Clayton
- Australia
| | - Beatriz Prieto-Simon
- Monash Institute of Pharmaceutical Sciences
- Monash University
- Parkville
- Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing
| | - Nicolas H. Voelcker
- Monash Institute of Pharmaceutical Sciences
- Monash University
- Parkville
- Australia
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing
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Tieu T, Alba M, Elnathan R, Cifuentes‐Rius A, Voelcker NH. Advances in Porous Silicon–Based Nanomaterials for Diagnostic and Therapeutic Applications. Adv Therap 2018. [DOI: 10.1002/adtp.201800095] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Terence Tieu
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Campus, 381 Royal Parade Parkville Victoria 3052 Australia
- T. Tieu, Dr. M. Alba, Prof. N. H. Voelcker CSIRO Manufacturing Bayview Avenue Clayton Victoria 3168 Australia
| | - Maria Alba
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Campus, 381 Royal Parade Parkville Victoria 3052 Australia
- T. Tieu, Dr. M. Alba, Prof. N. H. Voelcker CSIRO Manufacturing Bayview Avenue Clayton Victoria 3168 Australia
| | - Roey Elnathan
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Campus, 381 Royal Parade Parkville Victoria 3052 Australia
| | - Anna Cifuentes‐Rius
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Campus, 381 Royal Parade Parkville Victoria 3052 Australia
| | - Nicolas H. Voelcker
- Monash Institute of Pharmaceutical Sciences Monash University Parkville Campus, 381 Royal Parade Parkville Victoria 3052 Australia
- Prof. N. H. Voelcker Melbourne Centre for Nanofabrication Victorian Node of the Australian National Fabrication Facility 151 Wellington Road Clayton Victoria 3168 Australia
- T. Tieu, Dr. M. Alba, Prof. N. H. Voelcker CSIRO Manufacturing Bayview Avenue Clayton Victoria 3168 Australia
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Ruiz Á, Buitrago G, Nelcy R, Gómez C, Rodolfo D, Alba M, Chavez W, Araque C, Misas J, Sulo S, Gomez G. Prevalence and characterization of an undernourished inpatient population with cardiopulmonary diagnoses upon hospital admission at four colombian hospitals. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2055] [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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Ward MM, Hu J, Guthrie LC, Alba M. Testing the construct validity of a health transition question using vignette-guided patient ratings of health. Health Qual Life Outcomes 2018; 16:2. [PMID: 29298709 PMCID: PMC5751892 DOI: 10.1186/s12955-017-0832-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/20/2017] [Indexed: 11/23/2022] Open
Abstract
Background A single-item transition question is often used to assess improvement or worsening in health, but its validity has not been tested extensively. The purpose of this study was to test the construct validity of a transition question by relating it to qualitative changes in patient’s self-rating of health guided by clinical vignettes. Methods We studied 169 patients with active rheumatoid arthritis (RA) before and after treatment escalation. At both assessments, patients scored their current health on a rating scale after first rating three vignettes describing mild, moderate, or severe RA. We classified patients into one of these three RA categories using a nearest-neighbor match. We then related the change in these self-rated categories between visits to responses to a transition question on visit 2. Results Sixty patients improved their RA vignette category after treatment, 86 remained in the same vignette category, and 23 worsened categories. On the transition question, 101 patients reported improvement, 48 reported no change, and 20 reported worsening, representing a modest association with changes in RA vignette categories (polychoric correlation r = 0.19). The association was stronger if patients who were in the mild RA category at both visits were also classified as improved if their self-rating changed from below to above their mild vignette rating (r = 0.23) and when incorporating the importance of changes on the transition question (r = 0.26). Conclusion Changes in health states, guided by clinical vignettes, support the construct validity of the transition question.
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Affiliation(s)
- Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10 CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Jinxiang Hu
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10 CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Lori C Guthrie
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10 CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Maria Alba
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 10 CRC, Room 4-1339, 10 Center Drive, Bethesda, MD, 20892, USA
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Gutierrez-Barrios A, Medina F, Camacho H, Shorbaji L, Oneto J, Sanchez I, Agarrado A, Alba M, Garrido F, Vazquez R. P4276Eficient radiation dose reduction in the cathlab. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4276] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rodbard HW, Peters AL, Slee A, Cao A, Traina SB, Alba M. The Effect of Canagliflozin, a Sodium Glucose Cotransporter 2 Inhibitor, on Glycemic End Points Assessed by Continuous Glucose Monitoring and Patient-Reported Outcomes Among People With Type 1 Diabetes. Diabetes Care 2017; 40:171-180. [PMID: 27899497 DOI: 10.2337/dc16-1353] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the effects of canagliflozin, a sodium glucose cotransporter 2 inhibitor, on glycemic parameters and measures of glucose variability assessed by a 9-point self-monitoring blood glucose (SMBG) and continuous glucose monitoring (CGM) profiles, and patient-reported outcomes as an add-on to insulin among participants with type 1 diabetes. RESEARCH DESIGN AND METHODS In this randomized, double-blind study, 351 participants received canagliflozin 100 or 300 mg or placebo for 18 weeks. Change from baseline in daily mean glucose and SD was measured using a 9-point SMBG profile. In a subset of 89 participants who underwent CGM, the change from baseline in mean glucose, measures of glycemic variability (SD, coefficient of variation, and mean amplitude of glycemic excursions), and time spent in glycemic ranges were assessed. Change in treatment satisfaction was evaluated using the Diabetes Treatment Satisfaction Questionnaire (n = 328). RESULTS At week 18, reductions in daily mean glucose and SD measured using the 9-point SMBG profile were seen with canagliflozin 100 and 300 mg versus placebo. Reductions in mean glucose (-1.2, -0.7, and 0.6 mmol/L) and measures of glycemic variability assessed by CGM, such as changes in glucose SD (-0.3, -0.7, and 0.1 mmol/L), were also seen with canagliflozin 100 and 300 mg versus placebo, respectively. Canagliflozin 100 and 300 mg were associated with increases in time spent within target (glucose >3.9 to ≤10.0 mmol/L) compared with placebo (11.6%, 10.1%, and -3.5%, respectively) and commensurate reductions in time spent above the target level (glucose >10.0 mmol/L; -12.7%,-7.6%, and 5.7%, respectively). Participants showed greater improvement in treatment satisfaction with canagliflozin versus placebo; reductions in insulin dose, SD of glucose, and body weight contributed to the relationship between canagliflozin and satisfaction change. CONCLUSIONS Canagliflozin improved indices of glycemic variability and was associated with improvement in treatment satisfaction versus placebo over 18 weeks among participants with type 1 diabetes. Although these data from this study demonstrate the potential benefits of canagliflozin in people with type 1 diabetes, canagliflozin is not approved for the treatment of type 1 diabetes and should not currently be used in people with type 1 diabetes.
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Affiliation(s)
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Anjun Cao
- Janssen Research & Development, LLC, Raritan, NJ
| | | | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
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Seufert J, Rodbard H, Aggarwal N, Vijapurkar U, Fung A, Sikes C, Crean J, Pfeifer M, Alba M. Achievement of Composite Endpoint of HbA1c, Weight and Blood Pressure Reduction with Titrated Canagliflozin Added to Metformin+Sitagliptin in Patients with Type 2 Diabetes. Can J Diabetes 2016. [DOI: 10.1016/j.jcjd.2016.08.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alba M, Xie J, Fung A, Desai M. The effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on mineral metabolism and bone in patients with type 2 diabetes mellitus. Curr Med Res Opin 2016; 32:1375-85. [PMID: 27046479 DOI: 10.1080/03007995.2016.1174841] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 01/10/2023]
Abstract
BACKGROUND Sodium glucose co-transporter 2 (SGLT2) inhibitors lower blood glucose levels in patients with type 2 diabetes mellitus (T2DM) by increasing urinary glucose excretion. This review provides a comprehensive summary of preclinical and clinical data on the effects of the SGLT2 inhibitor canagliflozin on mineral balance and bone. METHODS Published articles and internal study reports through November 2015 were included. RESULTS In clinical studies, canagliflozin was not associated with meaningful changes in serum or urine calcium, parathyroid hormone, or vitamin D. Canagliflozin was associated with increases in serum magnesium and phosphate without changes in their urinary excretion. Increases in serum collagen type-1 beta-carboxy-telopeptide (beta-CTX), a bone resorption marker, and osteocalcin, a bone formation marker, were observed with canagliflozin. Decreases in total hip bone mineral density (BMD) of up to 1.2% were seen with canagliflozin after 2 years; no changes in BMD were seen at other skeletal sites. Changes in total hip BMD and serum beta-CTX with canagliflozin correlated with decreases in body weight. In a clinical program-wide analysis, canagliflozin was associated with increased fracture risk that was driven by a higher incidence in the cardiovascular safety study (CANVAS), with no fracture imbalance seen in pooled data from other Phase 3 studies. The fracture imbalance occurred within 12 weeks after initiating treatment, most frequently in the distal portion of the upper and lower extremities. CONCLUSIONS Across clinical studies, canagliflozin did not meaningfully affect calcium homeostasis or hormones regulating calcium homeostasis. Increases in bone turnover markers and decreases in BMD at the total hip, but not at other sites, that correlated with weight loss were seen with canagliflozin. Canagliflozin was associated with a higher fracture incidence within 12 weeks, primarily in distal extremities. Data from ongoing canagliflozin studies will provide additional information on fracture risk.
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Affiliation(s)
- Maria Alba
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - John Xie
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - Albert Fung
- a Janssen Research & Development, LLC , Raritan , NJ , USA
| | - Mehul Desai
- a Janssen Research & Development, LLC , Raritan , NJ , USA
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Rodbard HW, Seufert J, Aggarwal N, Cao A, Fung A, Pfeifer M, Alba M. Efficacy and safety of titrated canagliflozin in patients with type 2 diabetes mellitus inadequately controlled on metformin and sitagliptin. Diabetes Obes Metab 2016; 18:812-9. [PMID: 27160639 PMCID: PMC5089595 DOI: 10.1111/dom.12684] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/11/2016] [Accepted: 05/01/2016] [Indexed: 01/14/2023]
Abstract
AIMS To evaluate the efficacy and safety of titrated canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin and sitagliptin. METHODS In this randomized, double-blind study, patients with T2DM (N = 218) on metformin ≥1500 mg/day and sitagliptin 100 mg received canagliflozin 100 mg or placebo. After 6 weeks, the canagliflozin dose was increased from 100 to 300 mg (or from placebo to matching placebo) if all of the following criteria were met: baseline estimated glomerular filtration rate ≥70 ml/min/1.73 m(2) ; fasting self-monitored blood glucose ≥5.6 mmol/l (≥100 mg/dl); and no volume depletion-related adverse events (AEs) within 2 weeks before dose increase. Endpoints included change in glycated haemoglobin (HbA1c) at week 26 (primary); proportion of patients achieving HbA1c <7.0%; and changes in fasting plasma glucose (FPG), body weight and systolic blood pressure (SBP). Safety was assessed using AE reports. RESULTS Overall, 85.4% of patients were titrated to canagliflozin 300 mg or matching placebo (mean ± standard deviation time to titration 6.2 ± 0.8 weeks). At week 26, canagliflozin (pooled 100 and 300 mg) demonstrated superiority in HbA1c reduction versus placebo (-0.91% vs. -0.01%; p < 0.001). Canagliflozin provided significant reductions in FPG, body weight and SBP compared with placebo (p < 0.001). The overall AE incidence was 39.8 and 44.4% for canagliflozin and placebo, respectively. Canagliflozin was associated with an increased incidence of genital mycotic infections. CONCLUSIONS Titrated canagliflozin significantly improved HbA1c, FPG, body weight and SBP, and was generally well tolerated over 26 weeks in patients with T2DM as add-on to metformin and sitagliptin.
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Affiliation(s)
- H W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, USA
| | - J Seufert
- Department of Endocrinology and Diabetology, Clinic for Internal Medicine II, University Medical Center, Freiburg, Germany
| | - N Aggarwal
- Aggarwal and Associates Ltd, Brampton, ON, Canada
| | - A Cao
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - A Fung
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - M Pfeifer
- Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - M Alba
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Davidson JA, Aguilar R, Lavalle González FJ, Trujillo A, Alba M, Vijapurkar U, Meininger G. Efficacy and Safety of Canagliflozin in Type 2 Diabetes Patients of Different Ethnicity. Ethn Dis 2016; 26:221-8. [PMID: 27103773 PMCID: PMC4836903 DOI: 10.18865/ed.26.2.221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the efficacy and safety of the sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin in patients of different ethnicities. DESIGN SETTING AND PATIENTS Post hoc analysis of data pooled from four randomized, placebo-controlled, phase 3 studies of adults with inadequately controlled type 2 diabetes mellitus (T2DM). INTERVENTIONS Once daily oral canagliflozin 100 mg or 300 mg, or placebo. MAIN OUTCOME MEASURES Efficacy endpoints included change from baseline in HbA1c, body weight (BW), systolic blood pressure (SBP), and lipids at week 26; safety and tolerability were assessed by adverse event reports. RESULTS Of the 2,313 patients included in this pooled analysis, 609 self-identified as Hispanic/Latino. Hispanic/Latino patients had a mean age of 54 years, mean duration of T2DM of 7 years, mean HbA1c of 8.1%, mean body mass index of 31.2 kg/m(2), and mean SBP of 126.1 mm Hg. There were more women in the non-Hispanic/Latino cohort (63%) compared with the Hispanic/Latino cohort. Placebo-subtracted changes in HbA1c were -.82% with canagliflozin 100 mg and -.94% with canagliflozin 300 mg in the Hispanic/Latino cohort, which were similar to reductions observed in the non-Hispanic/Latino cohort. Significantly greater dose-related reductions in HbA1c, BW, and SBP were observed with both canagliflozin doses compared with placebo. Canagliflozin was generally well-tolerated. Genital mycotic infections were less frequent in Hispanic/Latino women than in non-Hispanic/Latino women. CONCLUSIONS The SGLT2 inhibitor canagliflozin was generally well-tolerated and was associated with clinically meaningful reductions in HbA1c, BW, and SBP in both Hispanic/Latino and non-Hispanic/Latino patients with T2DM.
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Affiliation(s)
- Jaime A. Davidson
- Touchstone Diabetes Center, University of Texas Southwestern Medical School
| | | | | | | | - Maria Alba
- Janssen Research and Development, LLC, Raritan, NJ
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Peters AL, Henry RR, Thakkar P, Tong C, Alba M. Diabetic Ketoacidosis With Canagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, in Patients With Type 1 Diabetes. Diabetes Care 2016; 39:532-8. [PMID: 26989182 DOI: 10.2337/dc15-1995] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 02/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the incidence of serious adverse events (AEs) of diabetic ketoacidosis (DKA) with canagliflozin, a sodium-glucose cotransporter 2 inhibitor, as an add-on to insulin in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS In this 18-week, randomized, double-blind, phase 2 study, patients (N = 351; HbA1c 7.0-9.0% [53-75 mmol/mol]) on multiple daily insulin injections or continuous subcutaneous insulin infusion received canagliflozin 100 or 300 mg or placebo once daily. The incidence of ketone-related AEs, defined as any event from a prespecified list of preferred terms (i.e., acidosis, blood ketone body increased, blood ketone body present, DKA, diabetic ketoacidotic hyperglycemic coma, ketoacidosis, ketonemia, ketonuria, ketosis, metabolic acidosis, urine ketone body present), including serious AEs of DKA, was assessed based on AE reports. RESULTS At week 18, the incidence of any ketone-related AE with canagliflozin 100 and 300 mg was 5.1% (n = 6 of 117) and 9.4% (n = 11 of 117), respectively; no patients in the placebo group experienced a ketone-related AE. The incidence of serious AEs of DKA was 4.3% (n = 5 of 117) with canagliflozin 100 mg and 6.0% (n = 7 of 117) with canagliflozin 300 mg; all serious events occurred in the presence of circumstances that are known to potentially precipitate DKA (e.g., infection, insulin pump failure). Among the 12 patients with a serious AE of DKA, blood glucose levels ranged from 9.4 to >44.4 mmol/L (170 to >800 mg/dL). Baseline characteristics were generally similar in patients with and without a ketone-related AE. CONCLUSIONS Canagliflozin was associated with an increased incidence of serious AEs of DKA in patients with type 1 diabetes inadequately controlled with insulin. Mitigation strategies are needed for use in future clinical trials to reduce the risk of DKA with canagliflozin treatment in patients with type 1 diabetes.
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Affiliation(s)
- Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Robert R Henry
- Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA University of California, San Diego, La Jolla, CA
| | | | - Cindy Tong
- Janssen Research & Development, LLC, Raritan, NJ
| | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
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Lavalle-González FJ, Eliaschewitz FG, Cerdas S, Chacon MDP, Tong C, Alba M. Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus from Latin America. Curr Med Res Opin 2016; 32:427-39. [PMID: 26579834 DOI: 10.1185/03007995.2015.1121865] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This post hoc analysis evaluated the efficacy and safety of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) from Latin America. RESEARCH DESIGN AND METHODS Analyses were performed in subgroups of patients from Latin America based on data from three individual, 26-week, placebo-controlled studies of canagliflozin (monotherapy [n = 116/584], add-on to metformin [n = 199/918], and add-on to metformin plus sulfonylurea [n = 76/469]) and three individual, 52-week, active-controlled studies of canagliflozin (add-on to metformin versus sitagliptin [n = 240/1101], add-on to metformin versus glimepiride [n = 155/1450], and add-on to metformin plus sulfonylurea versus sitagliptin [n = 156/755]). MAIN OUTCOME MEASURES Changes from baseline in HbA1c, body weight, and systolic blood pressure (BP) with canagliflozin 100 and 300 mg versus placebo or active comparator (i.e., sitagliptin or glimepiride) were evaluated in the overall study populations and Latin American subgroups. Safety was assessed based on adverse event (AE) reports. RESULTS Canagliflozin 100 and 300 mg provided reductions in HbA1c, body weight, and systolic BP across studies in patients from Latin America that were generally similar to those seen in the overall populations of patients with T2DM. The AE profile in patients from Latin America was equivalent to that in the overall populations; higher rates of genital mycotic infections and osmotic diuresis-related AEs were seen with canagliflozin versus comparators. Limitations of this study include the post hoc analysis of data and the small sample size of patients from Latin America. CONCLUSION Canagliflozin improved glycemic control, reduced body weight and systolic BP, and was generally well tolerated in patients with T2DM from Latin America. CLINICAL TRIAL REGISTRATION NCT01081834; NCT01106677; NCT01106625; NCT00968812; NCT01137812.
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Affiliation(s)
| | - Freddy G Eliaschewitz
- b b Hospital Israelita Albert Einstein and CPClin Clinical Research Center , São Paulo , Brazil
| | - Sonia Cerdas
- c c Hospital Cima, Centro de Investigacíon Clínica San Agustín , San José , Costa Rica
| | | | - Cindy Tong
- e e Janssen Research & Development, LLC , Raritan, NJ , USA
| | - Maria Alba
- e e Janssen Research & Development, LLC , Raritan, NJ , USA
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Henry RR, Thakkar P, Tong C, Polidori D, Alba M. Efficacy and Safety of Canagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, as Add-on to Insulin in Patients With Type 1 Diabetes. Diabetes Care 2015; 38:2258-65. [PMID: 26486192 DOI: 10.2337/dc15-1730] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/16/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed the efficacy and safety of canagliflozin, a sodium-glucose cotransporter 2 inhibitor, as add-on to insulin in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS This 18-week, double-blind, phase 2 study randomized 351 patients (HbA1c 7.0-9.0% [53-75 mmol/mol]) on multiple daily insulin injections or continuous subcutaneous insulin infusion to canagliflozin 100 or 300 mg or placebo. The primary end point was the proportion of patients achieving at week 18 both HbA1c reduction from baseline of ≥0.4% (≥4.4 mmol/mol) and no increase in body weight. Other end points included changes in HbA1c, body weight, and insulin dose, as well as hypoglycemia incidence. Safety was assessed by adverse event (AE) reports. RESULTS More patients had both HbA1c reduction ≥0.4% and no increase in body weight with canagliflozin 100 and 300 mg versus placebo at week 18 (36.9%, 41.4%, 14.5%, respectively; P < 0.001). Both canagliflozin doses provided reductions in HbA1c, body weight, and insulin dose versus placebo over 18 weeks. The incidence of hypoglycemia was similar across groups; severe hypoglycemia rates were low (1.7-6.8%). Overall incidence of AEs was 55.6%, 67.5%, and 54.7% with canagliflozin 100 and 300 mg and placebo; discontinuation rates were low (0.9-1.3%). Increased incidence of ketone-related AEs (5.1%, 9.4%, 0%), including the specific AE of diabetic ketoacidosis (DKA) (4.3%, 6.0%, 0%), was seen with canagliflozin 100 and 300 mg versus placebo. CONCLUSIONS Canagliflozin provided reductions in HbA1c, body weight, and insulin dose with no increase in hypoglycemia, but increased rates of ketone-related AEs, including DKA, in adults with type 1 diabetes inadequately controlled with insulin.
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Affiliation(s)
- Robert R Henry
- Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA University of California, San Diego, La Jolla, CA
| | | | - Cindy Tong
- Janssen Research & Development, LLC, Raritan, NJ
| | | | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
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Rosenthal N, Meininger G, Ways K, Polidori D, Desai M, Qiu R, Alba M, Vercruysse F, Balis D, Shaw W, Edwards R, Bull S, Di Prospero N, Sha S, Rothenberg P, Canovatchel W, Demarest K. Canagliflozin: a sodium glucose co-transporter 2 inhibitor for the treatment of type 2 diabetes mellitus. Ann N Y Acad Sci 2015; 1358:28-43. [PMID: 26305874 DOI: 10.1111/nyas.12852] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin is a novel treatment option for adults with type 2 diabetes mellitus (T2DM). In patients with hyperglycemia, SGLT2 inhibition lowers plasma glucose levels by reducing the renal threshold for glucose (RTG ) and increasing urinary glucose excretion (UGE). Increased UGE is also associated with a mild osmotic diuresis and net caloric loss, which can lead to reductions in body weight and blood pressure (BP). After promising results from preclinical and phase I/II studies, the efficacy and safety of canagliflozin was evaluated in a comprehensive phase III development program in over 10,000 patients with T2DM on various background therapies. Canagliflozin improved glycemic control and provided reductions in body weight and BP versus placebo and active comparators in studies of up to 2 years' duration. Canagliflozin was generally well tolerated, with higher incidences of adverse events (AEs) related to the mechanism of action, including genital mycotic infections and AEs related to osmotic diuresis. Results from the preclinical and clinical studies led canagliflozin to be the first-in-class SGLT2 inhibitor approved in the United States, and support canagliflozin as a safe and effective therapeutic option across a broad range of patients with T2DM.
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Affiliation(s)
- Norm Rosenthal
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Gary Meininger
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Kirk Ways
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - David Polidori
- Janssen Research & Development, LLC, San Diego, California
| | - Mehul Desai
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Rong Qiu
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Maria Alba
- Janssen Research & Development, LLC, Raritan, New Jersey
| | | | - Dainius Balis
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Wayne Shaw
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Robert Edwards
- Janssen Research & Development, LLC, Raritan, New Jersey
| | - Scott Bull
- Janssen Research & Development, LLC, Fremont, California
| | | | - Sue Sha
- Janssen Research & Development, LLC, Raritan, New Jersey
| | | | | | - Keith Demarest
- Janssen Research & Development, LLC, Raritan, New Jersey
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Formentín P, Catalán Ú, Fernández-Castillejo S, Alba M, Baranowska M, Solà R, Pallarès J, Marsal LF. Human aortic endothelial cell morphology influenced by topography of porous silicon substrates. J Biomater Appl 2015; 30:398-408. [PMID: 26017716 DOI: 10.1177/0885328215588414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Porous silicon has received much attention because of its optical properties and for its usefulness in cell-based biosensing, drug delivery, and tissue engineering applications. Surface properties of the biomaterial are associated with cell adhesion and with proliferation, migration, and differentiation. The present article analyzes the behavior of human aortic endothelial cells in macro- and nanoporous collagen-modified porous silicon samples. On both substrates, cells are well adhered and numerous. Confocal microscopy and scanning electron microscopy were employed to study the effects of porosity on the morphology of the cells. On macroporous silicon, filopodia is not observed but the cell spreads on the surface, increasing the lamellipodia surface which penetrates the macropore. On nanoporous silicon, multiple filopodia were found to branch out from the cell body. These results demonstrate that the pore size plays a key role in controlling the morphology and growth rate of human aortic endothelial cells, and that these forms of silicon can be used to control cell development in tissue engineering as well as in basic cell biology research.
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Affiliation(s)
- Pilar Formentín
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Úrsula Catalán
- Unit of Lipids and Atherosclerosis Research, Department of Medicine and Surgery, Universitat Rovira i Virgili, Tarragona, Spain
| | - Sara Fernández-Castillejo
- Unit of Lipids and Atherosclerosis Research, Department of Medicine and Surgery, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maria Alba
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Malgorzata Baranowska
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Rosa Solà
- Unit of Lipids and Atherosclerosis Research, Department of Medicine and Surgery, Universitat Rovira i Virgili, Tarragona, Spain
| | - Josep Pallarès
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Lluís F Marsal
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
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Baranowska M, Slota AJ, Eravuchira PJ, Alba M, Formentin P, Pallarès J, Ferré-Borrull J, Marsal LF. Protein attachment to silane-functionalized porous silicon: A comparison of electrostatic and covalent attachment. J Colloid Interface Sci 2015; 452:180-189. [PMID: 25942096 DOI: 10.1016/j.jcis.2015.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/16/2015] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/31/2022]
Abstract
Porous silicon (pSi) is a prosperous biomaterial, biocompatible, and biodegradable. Obtaining regularly functionalized pSi surfaces is required in many biotechnology applications. Silane-PEG-NHS (triethoxysilane-polyethylene-glycol-N-hydroxysuccinimide) is useful for single-molecule studies due to its ability to attach to only one biomolecule. We investigate the functionalization of pSi with silane-PEG-NHS and compare it with two common grafting agents: APTMS (3-aminopropylotrimethoxysilane) as electrostatic linker, and APTMS modified with glutaraldehyde as covalent spacer. We show the arrangement of two proteins (collagen and bovine serum albumin) as a function of the functionalization and of the pore size. FTIR is used to demonstrate correct functionalization while fluorescence confocal microscopy reveals that silane-PEG-NHS results in a more uniform protein distribution. Reflection interference spectroscopy (RIfS) is used to estimate the attachment of linker and proteins. The results open a way to obtain homogenous chemical modified silicon supports with a great value in biosensing, drug delivery and cell biology.
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Affiliation(s)
- Malgorzata Baranowska
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain
| | - Agata J Slota
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain
| | - Pinkie J Eravuchira
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain
| | - Maria Alba
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain
| | - Pilar Formentin
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain
| | - Josep Pallarès
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain
| | - Josep Ferré-Borrull
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain.
| | - Lluís F Marsal
- Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Avda. Països Catalans 26, Tarragona 43007, Spain.
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Neal B, Perkovic V, de Zeeuw D, Mahaffey KW, Fulcher G, Ways K, Desai M, Shaw W, Capuano G, Alba M, Jiang J, Vercruysse F, Meininger G, Matthews D. Efficacy and safety of canagliflozin, an inhibitor of sodium-glucose cotransporter 2, when used in conjunction with insulin therapy in patients with type 2 diabetes. Diabetes Care 2015; 38:403-11. [PMID: 25468945 DOI: 10.2337/dc14-1237] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There are limited data about the effects of sodium-glucose cotransporter 2 inhibitors when used with insulin. We report the efficacy and safety of canagliflozin in patients with type 2 diabetes using insulin. RESEARCH DESIGN AND METHODS The CANagliflozin CardioVascular Assessment Study is a double-blind, placebo-controlled study that randomized participants to placebo, canagliflozin 100 mg, or canagliflozin 300 mg once daily, added to a range of therapies. The primary end point of this substudy was the change in HbA1c from baseline at 18 weeks among patients using insulin; 52-week effects were also examined. RESULTS Individuals receiving insulin at baseline were randomized to receive placebo (n = 690), canagliflozin 100 mg (n = 692), or canagliflozin 300 mg (n = 690). These individuals were 66% male and had a median age of 63 years, mean HbA1c of 8.3% (67 mmol/mol), BMI of 33.1 kg/m(2), estimated glomerular filtration rate of 75 mL/min/1.73 m(2), fasting plasma glucose of 9.2 mmol/L, and a median daily insulin dose of 60 IU. Most individuals were using basal/bolus insulin. Reductions in HbA1c with canagliflozin 100 and 300 mg versus placebo were -0.62% (95% CI -0.69, -0.54; -6.8 mmol/mol [95% CI -7.5, -5.9]; P < 0.001) and -0.73% (95% CI -0.81, -0.65; -8.0 mmol/mol [95% CI -8.9, -7.1]; P < 0.001) at 18 weeks and -0.58% (95% CI -0.68, -0.48; -6.3 mmol/mol [95% CI -7.4, -5.2]) and -0.73% (95% CI -0.83, -0.63; -8.0 mmol/mol [95% CI -9.1, -6.9]) at 52 weeks. There were significant falls in fasting plasma glucose, body weight, and blood pressure at both time points and there was a greater incidence of hypoglycemia, genital mycotic infections, and hypovolemia with both canagliflozin doses. CONCLUSIONS Canagliflozin added to insulin therapy improved glycemic control and decreased body weight. There was a greater frequency of several anticipated side effects, although few led to discontinuation of treatment.
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Affiliation(s)
- Bruce Neal
- The George Institute for Global Health, The University of Sydney and the Royal Prince Alfred Hospital, Sydney, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, The University of Sydney and the Royal Prince Alfred Hospital, Sydney, Australia
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Kenneth W Mahaffey
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Greg Fulcher
- The Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - Kirk Ways
- Janssen Research & Development, LLC, Raritan, NJ
| | - Mehul Desai
- Janssen Research & Development, LLC, Raritan, NJ
| | - Wayne Shaw
- Janssen Research & Development, LLC, Raritan, NJ
| | | | - Maria Alba
- Janssen Research & Development, LLC, Raritan, NJ
| | - Joel Jiang
- Janssen Research & Development, LLC, Raritan, NJ
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Alba M, Esmaeilipour O, Mirmahmoudi R. Effects of Withania coagulans fruit powder and vitamin C on growth performance and some blood components in heat stressed broiler chickens. Livest Sci 2015. [DOI: 10.1016/j.livsci.2015.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gavin JR, Davies MJ, Davies M, Vijapurkar U, Alba M, Meininger G. The efficacy and safety of canagliflozin across racial groups in patients with type 2 diabetes mellitus. Curr Med Res Opin 2015; 31:1693-702. [PMID: 26121561 DOI: 10.1185/03007995.2015.1067192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 11/23/2022]
Abstract
OBJECTIVE Canagliflozin, a sodium-glucose co-transporter 2 inhibitor, enhances urinary glucose excretion through an insulin-independent mode of action, and improves glycemic control in patients with type 2 diabetes mellitus (T2DM). This study assessed the efficacy and safety of canagliflozin across racial groups. METHODS The efficacy of canagliflozin 100 mg and 300 mg was evaluated by racial group using data pooled from four placebo-controlled phase 3 studies and two placebo-controlled sub-studies of a population of patients with inadequately controlled T2DM (N = 4158). Least-squares mean changes from baseline were calculated for hemoglobin A1c (HbA1c), systolic blood pressure (SBP), body weight (BW), cholesterol, and triglycerides. Safety/tolerability evaluation included reporting of general and prespecified adverse events (AEs). RESULTS A total of 75% of patients were White, 13% were Asian, 4% were Black/African American, and 8% were 'Other' (American Indian, Alaskan Native, mixed race, Native Hawaiian or other Pacific Islander, not reported, and unknown). Baseline demographics were similar for these groups. Dose-related reductions in HbA1c, BW, and SBP were observed with both canagliflozin doses in all racial groups. Canagliflozin was generally safe and well tolerated. Treatment with canagliflozin was associated with an increased rate of genital mycotic infections (GMIs) and urinary tract infections (UTIs) in all racial groups. GMIs were observed more often in Black/African American males and males from the 'Other' racial group, whereas UTIs and osmotic diuresis-related AEs were less common in Asians. Key study limitations include the high proportion of White patients compared with other racial groups and the fact that included studies were not powered to evaluate racial differences. CONCLUSION Canagliflozin was generally well tolerated and consistently associated with reductions in HbA1c, BW, and SBP in patients with T2DM independent of racial background. (ClinicalTrials.gov numbers: NCT01081834; NCT01106677; NCT01106625; NCT01106690; and NCT01032629.).
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Affiliation(s)
- James R Gavin
- a a Emory University School of Medicine , Atlanta , GA , USA
| | - Melanie J Davies
- b b Diabetes Research Centre, University of Leicester , Leicester , UK
| | | | | | - Maria Alba
- d d Janssen Research & Development LLC , Raritan , NJ , USA
| | - Gary Meininger
- d d Janssen Research & Development LLC , Raritan , NJ , USA
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Valencia B, Jara M, Adaui V, Chantry M, Alba M, Ramos A, Arevalo J, Llanos-Cuentas A, Boggild A. Controversial role of leishmania RNA virus as a determinant of pathogenicity in human leishmaniasis. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Cordoba-Chacon J, Gahete MD, Pokala NK, Geldermann D, Alba M, Salvatori R, Luque RM, Kineman RD. Long- but not short-term adult-onset, isolated GH deficiency in male mice leads to deterioration of β-cell function, which cannot be accounted for by changes in β-cell mass. Endocrinology 2014; 155:726-35. [PMID: 24424062 PMCID: PMC3929744 DOI: 10.1210/en.2013-1825] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Developmental models of GH deficiency (GHD) and excess indicate that GH is positively associated with β-cell mass. Therefore, the reduction in GH levels observed with age and weight gain may contribute to the age-related decline in β-cell function. To test this hypothesis, β-cell mass and function were assessed in a mouse model of adult-onset, isolated GHD (AOiGHD). β-Cell mass did not differ between low-fat (LF)-fed AOiGHD and controls. However, high fat-fed AOiGHD mice displayed impaired expansion of β-cell mass and a reduction of bromodeoxyuridine-labeled islet cells, whereas in vitro β-cell function (basal and glucose-stimulated insulin secretion [GSIS]) did not differ from controls. In contrast, duration of AOiGHD differentially altered in vitro β-cell function in LF-fed mice. Specifically, islets from young LF-fed AOiGHD mice showed significant reductions in insulin content and basal insulin secretion, but GSIS was similar to that of controls. A similar islet phenotype was observed in a developmental model of isolated GHD (GH-releasing hormone knockout). Given that LF- and high fat-fed AOiGHD mice, as well as GH-releasing hormone knockout mice, display improved insulin sensitivity, islet changes may be due to reduced insulin demand, rather than primary β-cell dysfunction. However, islets from older LF-fed AOiGHD mice exhibited impaired GSIS, associated with reduced expression of genes important to maintain glucose sensing, suggesting that factors secondary to AOiGHD can alter β-cell function with age. AOiGHD mice exhibited postprandial hypertriglyceridemia and increased pancreatic expression of lipid/inflammatory stress response genes (activating transcription factor 3 and peroxisome proliferator activator receptor β/δ). Therefore, we speculate that these changes may initially protect the AOiGHD β-cell, but with age, lipotoxicity may impair β-cell function.
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Affiliation(s)
- Jose Cordoba-Chacon
- Research and Development Division (J.C.-C., M.D.G., N.K.P., D.G., R.D.K.), Jesse Brown Veterans Affairs Medical Center, and Section of Endocrinology, Diabetes, and Metabolism (J.C.-C., M.D.G., N.K.P., D.G., R.D.K.), Department of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612; Department of Cell Biology, Physiology, and Immunology (M.D.G., R.M.L.), University of Cordoba, Instituto Maimónides de Investigación Biomédica de Córdoba/Hospital Universitario Reina Sofia and Centros de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutricion, Cordoba 14014, Spain; and Division of Endocrinology, Diabetes, and Metabolism (M.A., R.S.), School of Medicine, Johns Hopkins University, Baltimore, Maryland 21218
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Stenlöf K, Cefalu WT, Kim KA, Jodar E, Alba M, Edwards R, Tong C, Canovatchel W, Meininger G. Long-term efficacy and safety of canagliflozin monotherapy in patients with type 2 diabetes inadequately controlled with diet and exercise: findings from the 52-week CANTATA-M study. Curr Med Res Opin 2014; 30:163-75. [PMID: 24073995 DOI: 10.1185/03007995.2013.850066] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Canagliflozin is a sodium glucose co-transporter 2 inhibitor developed for treatment of type 2 diabetes mellitus (T2DM). The long-term efficacy and safety of canagliflozin monotherapy were evaluated over 52 weeks in patients with T2DM inadequately controlled with diet and exercise. RESEARCH DESIGN AND METHODS This randomized, double-blind, Phase 3 study included a placebo-controlled, 26-week core period (canagliflozin 100 or 300 mg vs placebo) and an active-controlled, 26-week extension (blinded switch of placebo-treated patients to sitagliptin 100 mg [placebo/sitagliptin]). CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01081834. MAIN OUTCOME MEASURES Efficacy endpoints assessed at 52 weeks included changes in hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and systolic blood pressure (BP); and percentage changes in body weight and fasting plasma lipids. Adverse events (AEs) were recorded throughout the study. Efficacy data are reported for canagliflozin 100 and 300 mg (placebo/sitagliptin group was used to maintain the double-blind and to serve as a control group for safety purposes; not as an efficacy comparator); safety data are reported for canagliflozin 100 and 300 mg and placebo/sitagliptin. RESULTS Efficacy analyses included 451 patients who were randomized and dosed, entered the extension, and did not receive rescue therapy during the core period. Safety analyses included 584 patients who were randomized and dosed. At Week 52, canagliflozin 100 and 300 mg provided dose-related decreases from baseline in HbA1c of -0.81% and -1.11%. Canagliflozin 100 and 300 mg decreased FPG (-1.5 and -2.2 mmol/L [-27.4 and -39.1 mg/dL]), body weight (-3.3% and -4.4%), and systolic BP (-1.4 and -3.9 mmHg); decreased triglycerides and increased HDL-C and LDL-C were also seen. Over 52 weeks, overall AE rates were 67.2%, 66.0%, and 64.1% with canagliflozin 100 and 300 mg and placebo/sitagliptin; rates of serious AEs and AE-related discontinuations were low across groups. Compared with placebo/sitagliptin, canagliflozin was associated with higher rates of genital mycotic infections and AEs related to osmotic diuresis; these led to few discontinuations. Rates of volume depletion AEs and documented hypoglycemia were low across groups. CONCLUSIONS Canagliflozin monotherapy provided sustained improvement in glycemic control and body weight reduction, and was generally well tolerated in patients with T2DM over 52 weeks.
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Affiliation(s)
- Kaj Stenlöf
- Clinical Trial Center, Sahlgrenska University Hospital , Gothenburg , Sweden
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García-Martínez A, Arguis P, Prieto-González S, Hernández-Rodríguez J, Espígol G, Corbera M, Alba M, Tavera I, Planas E, Cid M. THU0202 Prospective evaluation of aortic structural damage (aneurysm/dilatation) using a predefined screening protocol in biopsy-proven giant-cell arteritis patients during long-term follow-up. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.2167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Alba M, Romano E, Formentín P, Eravuchira PJ, Ferré-Borrull J, Pallarès J, Marsal LF. Selective dual-side functionalization of hollow SiO2 micropillar arrays for biotechnological applications. RSC Adv 2014. [DOI: 10.1039/c3ra48062c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Alba M, Ahrén B, Inzucchi SE, Guan Y, Mallick M, Xu L, O'Neill EA, Williams-Herman DE, Kaufman KD, Goldstein BJ. Sitagliptin and pioglitazone provide complementary effects on postprandial glucose and pancreatic islet cell function. Diabetes Obes Metab 2013; 15:1101-10. [PMID: 23782502 DOI: 10.1111/dom.12145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Received: 02/01/2013] [Revised: 03/09/2013] [Accepted: 06/11/2013] [Indexed: 12/21/2022]
Abstract
AIMS The effects of sitagliptin and pioglitazone, alone and in combination, on α- and β-cell function were assessed in patients with type 2 diabetes. METHODS Following a 6-week diet/exercise period, 211 patients with HbA1c of 6.5-9.0% and fasting plasma glucose of 7.2-14.4 mmol/l were randomized (1 :1 :1 : 1) to sitagliptin, pioglitazone, sitagliptin + pioglitazone or placebo. At baseline and after 12 weeks, patients were given a mixed meal followed by frequent blood sampling for measurements of glucose, insulin, C-peptide and glucagon. RESULTS After 12 weeks, 5-h glucose total area under the curve (AUC) decreased in all active treatments versus placebo; reduction with sitagliptin + pioglitazone was greater versus either monotherapy. The 5-h insulin total AUC increased with sitagliptin versus all other treatments and increased with sitagliptin + pioglitazone versus pioglitazone. The 3-h glucagon AUC decreased with sitagliptin versus placebo and decreased with sitagliptin + pioglitazone versus pioglitazone or placebo. Φ(s), a measure of dynamic β-cell responsiveness to above-basal glucose concentrations, increased with either monotherapy versus placebo and increased with sitagliptin + pioglitazone versus either monotherapy. The insulin sensitivity index (ISI), a composite index of insulin sensitivity, improved with pioglitazone and sitagliptin + pioglitazone versus placebo. The disposition index, a measure of the relationship between β-cell function and insulin sensitivity, improved with all active treatments versus placebo. CONCLUSIONS Sitagliptin and pioglitazone enhanced β-cell function (increasing postmeal Φ(s)), and sitagliptin improved α-cell function (decreasing postmeal glucagon) after 12 weeks in patients with type 2 diabetes. Through these complementary mechanisms of action, the combination of sitagliptin and pioglitazone reduced postmeal glucose more than either treatment alone.
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Affiliation(s)
- M Alba
- Merck & Co., Inc., Whitehouse Station, NJ, USA
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Alba M, Pazos-Perez N, Vaz B, Formentin P, Tebbe M, Correa-Duarte MA, Granero P, Ferré-Borrull J, Alvarez R, Pallares J, Fery A, de Lera AR, Marsal LF, Alvarez-Puebla RA. Innenrücktitelbild: Macroscale Plasmonic Substrates for Highly Sensitive Surface-Enhanced Raman Scattering (Angew. Chem. 25/2013). Angew Chem Int Ed Engl 2013. [DOI: 10.1002/ange.201304231] [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: 11/08/2022]
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Alba M, Pazos-Perez N, Vaz B, Formentin P, Tebbe M, Correa-Duarte MA, Granero P, Ferré-Borrull J, Alvarez R, Pallares J, Fery A, de Lera AR, Marsal LF, Alvarez-Puebla RA. Inside Back Cover: Macroscale Plasmonic Substrates for Highly Sensitive Surface-Enhanced Raman Scattering (Angew. Chem. Int. Ed. 25/2013). Angew Chem Int Ed Engl 2013. [DOI: 10.1002/anie.201304231] [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: 11/10/2022]
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Alba M, Pazos-Perez N, Vaz B, Formentin P, Tebbe M, Correa-Duarte MA, Granero P, Ferré-Borrull J, Alvarez R, Pallares J, Fery A, de Lera AR, Marsal LF, Alvarez-Puebla RA. Macroscale Plasmonic Substrates for Highly Sensitive Surface-Enhanced Raman Scattering. Angew Chem Int Ed Engl 2013. [DOI: 10.1002/ange.201302285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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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Alba M, Pazos-Perez N, Vaz B, Formentin P, Tebbe M, Correa-Duarte MA, Granero P, Ferré-Borrull J, Alvarez R, Pallares J, Fery A, de Lera AR, Marsal LF, Alvarez-Puebla RA. Macroscale plasmonic substrates for highly sensitive surface-enhanced Raman scattering. Angew Chem Int Ed Engl 2013; 52:6459-63. [PMID: 23630080 PMCID: PMC3749443 DOI: 10.1002/anie.201302285] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Maria Alba
- Department of Electronic Engineering, Universitat Rovira i Virgili, Avda. Països Catalans, 26, 43007 Tarragona, Spain
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Stenlöf K, Cefalu WT, Kim KA, Alba M, Usiskin K, Tong C, Canovatchel W, Meininger G. Efficacy and safety of canagliflozin monotherapy in subjects with type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetes Obes Metab 2013; 15:372-82. [PMID: 23279307 PMCID: PMC3593184 DOI: 10.1111/dom.12054] [Citation(s) in RCA: 467] [Impact Index Per Article: 42.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 11/22/2012] [Accepted: 12/15/2012] [Indexed: 12/11/2022]
Abstract
AIMS Canagliflozin is a sodium glucose co-transporter 2 inhibitor in development for type 2 diabetes mellitus (T2DM). The efficacy and safety of canagliflozin were evaluated in subjects with T2DM inadequately controlled with diet and exercise. METHODS In this 26-week, randomized, double-blind, placebo-controlled, phase 3 trial, subjects (N = 584) received canagliflozin 100 or 300 mg or placebo once daily. Primary endpoint was the change from baseline in haemoglobin A1c (HbA1c) at week 26. Secondary endpoints included the proportion of subjects achieving HbA1c < 7.0%; change from baseline in fasting plasma glucose (FPG), 2-h postprandial glucose (PPG) and systolic blood pressure (BP); and percent change in body weight, high-density lipoprotein cholesterol (HDL-C) and triglycerides. Adverse events (AEs) were recorded throughout the study. RESULTS At week 26, HbA1c was significantly reduced from baseline with canagliflozin 100 and 300 mg compared with placebo (-0.77, -1.03 and 0.14%, respectively; p < 0.001 for both). Both canagliflozin doses significantly decreased FPG, 2-h PPG, body weight and systolic BP (p < 0.001 for all), and increased HDL-C compared with placebo (p < 0.01 for both). Overall incidences of AEs were modestly higher with canagliflozin versus placebo; rates of serious AEs and AE-related discontinuations were low and similar across groups. Incidences of genital mycotic infections, urinary tract infections and osmotic diuresis-related AEs were higher with canagliflozin; these led to few discontinuations. The incidence of hypoglycaemia was low across groups. CONCLUSION Canagliflozin treatment improved glycaemic control, reduced body weight and was generally well tolerated in subjects with T2DM inadequately controlled with diet and exercise.
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Affiliation(s)
- K Stenlöf
- Clinical Trial Center, Sahlgrenska University Hospital, Gothenburg, Sweden.
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